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Choi HS, Yun J, Jeong Y, Jo YK, Cha HJ. Self-controllable proteinic antibacterial coating with bacteria-triggered antibiotic release for prevention of periprosthetic infection. Biomaterials 2024; 305:122457. [PMID: 38171117 DOI: 10.1016/j.biomaterials.2023.122457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 11/28/2023] [Accepted: 12/29/2023] [Indexed: 01/05/2024]
Abstract
Periprosthetic infection is a devastating postimplantation complication in which a biofilm layer harboring invasive microorganisms forms around orthopedic implants, leading to severe implant failure and patient morbidity. Despite the development of several infection-triggered antibiotic release approaches, most current antibacterial coatings are susceptible to undesired antibiotic leakage or mechanical disintegration during prosthesis installation. Herein, we propose a self-controllable proteinic antibacterial coating capable of both long-lasting adherence onto titanium implant substrates over the implant fixation period and instantaneous bacterial eradication. Importantly, the pH-dependent reversible metal coordination of mussel adhesive protein (MAP) enabled bacterial concentration-dependent antibiotic delivery in response to infection-induced acidification. In addition, the MAP coating exhibited superior self-healable adhesive properties and scratch resistance, which enabled to avert issues associated with mechanical damages, including peeling and cracking, often occurring in conventional implant coating systems. The gentamicin-loaded MAP coating exhibited complete inhibition of bacterial growth in vivo against Staphylococcus aureus penetrations during implantation surgery (immediate infection) and even 4 weeks after implantation (delayed infection). Thus, our antibiotic-loaded MAP hydrogel coating can open new avenues for self-defensive antibiotic prophylaxis to achieve instant and sustainable bacteriocidal activity in orthopedic prostheses. © 2017 Elsevier Inc. All rights reserved.
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Affiliation(s)
- Hyun Sun Choi
- Department of Chemical Engineering, Pohang University of Science and Technology, Pohang 37673, Republic of Korea
| | - Jinyoung Yun
- Department of Chemical Engineering, Pohang University of Science and Technology, Pohang 37673, Republic of Korea
| | - Yeonsu Jeong
- Department of Chemical Engineering, Pohang University of Science and Technology, Pohang 37673, Republic of Korea
| | - Yun Kee Jo
- Department of Biomedical Convergence Science and Technology, School of Convergence, Kyungpook National University, Daegu 41566, Republic of Korea; Cell and Matrix Research Institute, Kyungpook National University, Daegu 41944, Republic of Korea.
| | - Hyung Joon Cha
- Department of Chemical Engineering, Pohang University of Science and Technology, Pohang 37673, Republic of Korea; Medical Science and Engineering, School of Convergence Science and Technology, Pohang University of Science and Technology, Pohang 37673, Republic of Korea.
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You C, Cao J, Du Y, Peng C, Cheng L, Ren J, Zhang W, Zheng H, Guo K, Gao X, Zhang F, Wang J, Li H, Liu T. ε-Poly-l-lysine-hydroxyphenyl propionic acid/IL-4 composite hydrogels with inflammation regulation and antibacterial activity for improving integration stability of soft tissues and orthopedic implants. Int J Biol Macromol 2024; 254:127937. [PMID: 37939753 DOI: 10.1016/j.ijbiomac.2023.127937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 10/31/2023] [Accepted: 11/05/2023] [Indexed: 11/10/2023]
Abstract
The failure of orthopedic implants is usually caused by inflammation, poor tissue integration, and infection, which can lead to pain, limited mobility, dysfunction of patients. This may require additional surgical interventions, such as removal, replacement, or repair of implants, as well as related treatment measures such as antibiotic therapy, physical therapy. Here, an injectable hydrogel carrier was developed for the steady release of inflammatory regulators to reduce the surface tissue inflammatory response of orthopedic implants and induce soft tissue regeneration, ultimately achieving the promotion of implants stability. The hydrogels carrier was prepared by hydroxyphenyl propionic acid-modified ε-Poly-l-lysine (EPA), hydrogen peroxide and horseradish peroxidase, which showed antibacterial bioactive and stable factor release ability. Due to the introduction of IL-4, EPA@IL-4 hydrogels showed good inflammatory regulation. EPA@IL-4 hydrogels regulated the differentiation of macrophages into M2 in inflammatory environment in vitro, and promoted endothelial cells to show a more obvious trend of tube formation. The composite hydrogels reduced the inflammation on the surface of the implants in vivo, induced local endothelial cell angiogenesis, and had more collagen deposition and new granulation tissue. Therefore, EPA hydrogels based on IL-4 release are promising candidates for promoting of implants surface anti-inflammatory, soft tissue regeneration, and anti-infection.
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Affiliation(s)
- Chaoqun You
- Department of Orthopaedic Oncology, Changzheng Hospital of the Navy Medical University, No. 415 Fengyang Road, Shanghai 200003, China; Department of Orthopedics, Clinical Medical College, Weifang Medical University, No. 7166 Baotong West Street, Weifang, Shandong 261000, China
| | - Jiashi Cao
- Department of Orthopaedic Oncology, Changzheng Hospital of the Navy Medical University, No. 415 Fengyang Road, Shanghai 200003, China; Department of Orthopedics, No. 455 Hospital of the Chinese People's Liberation Army, The Navy Medical University, No. 338 Huaihai West Road, Shanghai 200052, China
| | - Yan Du
- College of Physical Science and Technology, Sichuan University, Chengdu 610065, China
| | - Cheng Peng
- Department of Orthopaedic Oncology, Changzheng Hospital of the Navy Medical University, No. 415 Fengyang Road, Shanghai 200003, China
| | - Linfei Cheng
- School of Medicine, Anhui University of Science and Technology, No.168 Taifeng Road, Huainan 232001, China
| | - Jiaji Ren
- Department of Orthopaedic Oncology, Changzheng Hospital of the Navy Medical University, No. 415 Fengyang Road, Shanghai 200003, China; Department of Orthopedics, Clinical Medical College, Weifang Medical University, No. 7166 Baotong West Street, Weifang, Shandong 261000, China
| | - Wanli Zhang
- College of Physical Science and Technology, Sichuan University, Chengdu 610065, China
| | - Heng Zheng
- College of Physical Science and Technology, Sichuan University, Chengdu 610065, China
| | - Kai Guo
- Department of Orthopedics, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, No. 164 Lanxi Road, Shanghai 200062, China
| | - Xin Gao
- Department of Orthopaedic Oncology, Changzheng Hospital of the Navy Medical University, No. 415 Fengyang Road, Shanghai 200003, China
| | - Fei Zhang
- Ningbo Beilun Changzheng Orthopaedic Hospital, 458 Fengyang 1st Road, Beilun District, Ningbo, Zhejiang 315800, China
| | - Jing Wang
- Department of Orthopaedic Oncology, Changzheng Hospital of the Navy Medical University, No. 415 Fengyang Road, Shanghai 200003, China.
| | - Hong Li
- College of Physical Science and Technology, Sichuan University, Chengdu 610065, China.
| | - Tielong Liu
- Department of Orthopaedic Oncology, Changzheng Hospital of the Navy Medical University, No. 415 Fengyang Road, Shanghai 200003, China; Department of Orthopedics, Clinical Medical College, Weifang Medical University, No. 7166 Baotong West Street, Weifang, Shandong 261000, China.
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Arteaga A, Biguetti CC, Chandrashekar B, La Fontaine J, Rodrigues DC. Revolutionizing fracture fixation in diabetic and non-diabetic rats: High mobility group box 1-based coating for enhanced osseointegration. Bone 2023; 177:116917. [PMID: 37739297 DOI: 10.1016/j.bone.2023.116917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 09/16/2023] [Accepted: 09/18/2023] [Indexed: 09/24/2023]
Abstract
Chronic inflammation and hyperglycemia in diabetic patients increase the risk of implant failure and impaired fracture healing. We previously developed and characterized a titanium (Ti) coating strategy using an imidazolium-based ionic liquid (IonL) with a fully reduced, non-oxidizable High Mobility Group Box 1 (HMGB1) isoform (Ti-IonL-HMGB1) to immunomodulate tissue healing. In this study, we used an open reduction fracture fixation (ORIF) model in non-diabetic (ND) and diabetic (D) rats to further investigate the effectiveness of this Ti-IonL-HMGB1 coating on orthopedic applications. Ninety male Lewis rats (12-15 weeks) were divided into D (n = 45) and ND (n = 45) groups that were distributed into three subgroups based on the type of local treatment received: Ti (uncoated Ti), Ti-IonL, and Ti-IonL-HMGB1 implants. Fracture healing and osseointegration were evaluated using microtomographic, histological, and immunohistochemical analysis of proliferating cell nuclear antigen (PCNA), Runt-related transcription factor 2 (RUNX2), and HMGB1 markers at 2, 10, and 21 days post-ORIF. Scanning Electron Microscopy verified the coating stability after placement. Microtomographic and histological analysis demonstrated increased fracture healing and osseointegration for ND rats in all treatment groups at 10 days, with impaired healing for D rats. Immunohistochemical analysis exhibited elevated PCNA+ and RUNX2+ cells for D animals treated with Ti-IonL-HMGB1 at 21 days compared to all other groups. The immunohistochemical marker HMGB1 was elevated at all time points for D animals in comparison to ND animals, yet was lowered for D tissues near the Ti-IonL-HMGB1 treated implant. Improved osseous healing was demonstrated in D animals with Ti-IonL-HMGB1 treatment by 21 days, compared to D animals with other treatments. To the best of our knowledge, this is the first study analyzing Ti-IonL-HMGB1 implantation in an injury site through ORIF procedures in ND and D rats. This surface approach has potential for improving implanted biomaterials in diabetic environments.
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Affiliation(s)
- Alexandra Arteaga
- Department of Bioengineering, The University of Texas at Dallas, Richardson, TX, USA
| | - Claudia Cristina Biguetti
- Department of Surgery and Biomechanics, School of Podiatric Medicine, The University of Texas Rio Grande Valley, Harlingen, TX, USA
| | | | - Javier La Fontaine
- Department of Surgery and Biomechanics, School of Podiatric Medicine, The University of Texas Rio Grande Valley, Harlingen, TX, USA
| | - Danieli C Rodrigues
- Department of Bioengineering, The University of Texas at Dallas, Richardson, TX, USA.
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Zhang H, Yi X, Chen M, Shi H, Tan L, Lu H, Sun Y, Yang F. Synergistic effect of chlorhexidine and azoles on candida biofilm on titanium surface. J Mycol Med 2023; 33:101417. [PMID: 37619456 DOI: 10.1016/j.mycmed.2023.101417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 05/06/2023] [Accepted: 07/21/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND Candida infections of orthopedic implants are one of the most detrimental orthopedic implant-related complications with unsuccessful treatment and a poor prognosis. Most orthopedic Candida infections form biofilms and have resistance to the commonly used antifungal agents. This study aimed to develop a novel combination of normally prescribed drugs against Candida biofilm on orthopedic implants. METHODS We cultured 26 clinical isolates of Candida strains to form biofilm without titanium sheets or on titanium sheets, which are the most commonly used materials for permanent or orthopedic implants. The checkerboard method was used to evaluate the synergistic effects of chlorhexidine (CHL) and azoles on these Candida biofilms. For the evaluation of synergistic effects, we constructed the cell viability assay by fluorescence staining and CFU reduction hot map of Candida. RESULTS Twenty-six clinical isolates of Candida strains formed biofilm in 96-well plates without titanium sheets, and we selected 9 of them to form biofilm on titanium sheets in 24-well plates. In Candida biofilm formed in 96-wells, the synergistic rates of CHL with fluconazole, itraconazole, and voriconazole were 61% (16/26), 65% (17/26), and 23% (6/26), respectively. When compared to the blank control group, CHL monotherapy significantly inhibited biofilm formation on titanium sheets (P < 0.05). We demonstrated 100% synergistic rates of the CHL and fluconazole combination against Candida biofilm formation on titanium sheets, and the minimum inhibitory concentration of CHL and FLU decreased four- to eight-fold. CONCLUSIONS We concluded that CHL combined with azoles inhibited the Candida biofilm formation 96-wells or on titanium sheets and has the potential to control the infections of orthopedic implants.
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Affiliation(s)
- Heng Zhang
- Department of Dermatology, Jingzhou Hospital Affiliated to Yangtze University, Jingzhou, Hubei, China
| | - Xuesong Yi
- Department of Orthopedics, the First People's Hospital of Jingzhou, First Affiliated Hospital of Yangtze University, Jingzhou, Hubei, China
| | - Mei Chen
- Department of Dermatology, Jingzhou Hospital Affiliated to Yangtze University, Jingzhou, Hubei, China
| | - Haiyan Shi
- Department of Dermatology, Jingzhou Hospital Affiliated to Yangtze University, Jingzhou, Hubei, China
| | - Lihua Tan
- Department of Dermatology, Jingzhou Hospital Affiliated to Yangtze University, Jingzhou, Hubei, China
| | - Hougen Lu
- Department of Orthopedics, Jingzhou Hospital Affiliated to Yangtze University, Jingzhou, Hubei, China
| | - Yi Sun
- Department of Dermatology, Jingzhou Hospital Affiliated to Yangtze University, Jingzhou, Hubei, China
| | - Fei Yang
- Department of Medical Cell Biology and Genetics, Health Science Center, Yangtze University, Jingzhou, Hubei, China.
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Qian J, Wang J, Zhang W, Mao J, Qin H, Ling X, Zeng H, Hou J, Chen Y, Wan G. Corrosion-tailoring, osteogenic, anti-inflammatory, and antibacterial aspirin-loaded organometallic hydrogel composite coating on biodegradable Zn for orthopedic applications. Biomater Adv 2023; 153:213536. [PMID: 37418934 DOI: 10.1016/j.bioadv.2023.213536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 06/05/2023] [Accepted: 06/22/2023] [Indexed: 07/09/2023]
Abstract
Zn and its alloys are receiving increasing interest for biodegradable orthopedic implant applications owing to their moderate corrosion rate and the potential functionality of Zn2+. However, their non-uniform corrosion behavior and insufficient osteogenic, anti-inflammatory, and antibacterial properties do not meet the comprehensive requirements of orthopedic implants in clinical use. Herein, an aspirin (an acetylsalicylic acid, ASA, 10, 50, 100, and 500 mg/L)-loaded carboxymethyl chitosan (CMC)/gelatin (Gel)-Zn2+ organometallic hydrogel composite coating (CMC/Gel&Zn2+/ASA) was fabricated on a Zn surface via an alternating dip-coating method, aiming to obtain a material with these comprehensive properties improved. The organometallic hydrogel composite coatings, ca. 12-16 μm in thickness, showed compact, homogeneous, and micro-bulge structured surface morphology. The coatings protected well the Zn substrate from pitting/localized corrosion and contained the release of the bioactive components, Zn2+ and ASA, in a sustained and stable manner in long-term in vitro immersions in Hank's solution. The coated Zn showed greater ability to promote proliferation and osteogenic differentiation for MC3T3-E1 osteoblasts, and better anti-inflammatory capacity when compared with uncoated Zn. Additionally, this coating displayed excellent antibacterial activity against both Escherichia coli (>99 % antibacterial rate) and Staphylococcus aureus (>98 % antibacterial rate). Such appealing properties can be attributed to the compositional nature of the coating, namely the sustained release of Zn2+ and ASA, as well as the surface physiochemical properties because of its unique microstructure. This organometallic hydrogel composite coating can be considered a promising option for the surface modification of biodegradable Zn-based orthopedic implants among others.
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Affiliation(s)
- Junyu Qian
- Institute of Biomedical Engineering, College of Medicine, Southwest Jiaotong University, Chengdu 610031, China; Key Laboratory of Advanced Technologies of Materials, Ministry of Education, School of Materials Science and Engineering, Southwest Jiaotong University, Chengdu 610031, China
| | - Jiale Wang
- Key Laboratory of Advanced Technologies of Materials, Ministry of Education, School of Materials Science and Engineering, Southwest Jiaotong University, Chengdu 610031, China
| | - Wentai Zhang
- Key Laboratory of Advanced Technologies of Materials, Ministry of Education, School of Materials Science and Engineering, Southwest Jiaotong University, Chengdu 610031, China
| | - Jinlong Mao
- Institute of Biomedical Engineering, College of Medicine, Southwest Jiaotong University, Chengdu 610031, China; Key Laboratory of Advanced Technologies of Materials, Ministry of Education, School of Materials Science and Engineering, Southwest Jiaotong University, Chengdu 610031, China
| | - Haotian Qin
- Department of Bone & Joint Surgery, National & Local Joint Engineering Research Centre of Orthopaedic Biomaterials, Peking University Shenzhen Hospital, Shenzhen 518036, China
| | - Xuyu Ling
- Department of Applied Physics, College of Electronic and Information, Southwest Minzu University, Chengdu 610041, China
| | - Hui Zeng
- Department of Bone & Joint Surgery, National & Local Joint Engineering Research Centre of Orthopaedic Biomaterials, Peking University Shenzhen Hospital, Shenzhen 518036, China
| | - Jiaming Hou
- Institute of Biomedical Engineering, College of Medicine, Southwest Jiaotong University, Chengdu 610031, China; Key Laboratory of Advanced Technologies of Materials, Ministry of Education, School of Materials Science and Engineering, Southwest Jiaotong University, Chengdu 610031, China
| | - Yingqi Chen
- Department of Bone & Joint Surgery, National & Local Joint Engineering Research Centre of Orthopaedic Biomaterials, Peking University Shenzhen Hospital, Shenzhen 518036, China.
| | - Guojiang Wan
- Institute of Biomedical Engineering, College of Medicine, Southwest Jiaotong University, Chengdu 610031, China; Key Laboratory of Advanced Technologies of Materials, Ministry of Education, School of Materials Science and Engineering, Southwest Jiaotong University, Chengdu 610031, China.
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Spronk T, Kraff O, Schaefers G, Quick HH. Numerical approach to investigate MR imaging artifacts from orthopedic implants at different field strengths according to ASTM F2119. MAGMA 2023; 36:725-735. [PMID: 36933090 PMCID: PMC10504103 DOI: 10.1007/s10334-023-01074-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 02/24/2023] [Accepted: 02/26/2023] [Indexed: 03/19/2023]
Abstract
OBJECTIVE This study presents an extended evaluation of a numerical approach to simulate artifacts of metallic implants in an MR environment. METHODS The numerical approach is validated by comparing the artifact shape of the simulations and measurements of two metallic orthopedic implants at three different field strengths (1.5 T, 3 T, and 7 T). Furthermore, this study presents three additional use cases of the numerical simulation. The first one shows how numerical simulations can improve the artifact size evaluation according to ASTM F2119. The second use case quantifies the influence of different imaging parameters (TE and bandwidth) on the artifact size. Finally, the third use case shows the potential of performing human model artifact simulations. RESULTS The numerical simulation approach shows a dice similarity coefficient of 0.74 between simulated and measured artifact sizes of metallic implants. The alternative artifact size calculation method presented in this study shows that the artifact size of the ASTM-based method is up to 50% smaller for complex shaped implants compared to the numerical-based approach. CONCLUSION In conclusion, the numerical approach could be used in the future to extend MR safety testing according to a revision of the ASTM F2119 standard and for design optimization during the development process of implants.
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Affiliation(s)
- Tobias Spronk
- Erwin L. Hahn Institute for MR Imaging, University of Duisburg-Essen, Kokereiallee 7, Building C84, 45141, Essen, Germany.
- High-Field and Hybrid MR Imaging, University Hospital Essen, University Duisburg-Essen, Essen, Germany.
- MRI-STaR Magnetic Resonance Institute for Safety GmbH, Technology and Research GmbH, Gelsenkirchen, Germany.
| | - Oliver Kraff
- Erwin L. Hahn Institute for MR Imaging, University of Duisburg-Essen, Kokereiallee 7, Building C84, 45141, Essen, Germany
| | - Gregor Schaefers
- MRI-STaR Magnetic Resonance Institute for Safety GmbH, Technology and Research GmbH, Gelsenkirchen, Germany
- MR:Comp GmbH, Testing Services for MR Safety and Compatibility, Gelsenkirchen, Germany
| | - Harald H Quick
- Erwin L. Hahn Institute for MR Imaging, University of Duisburg-Essen, Kokereiallee 7, Building C84, 45141, Essen, Germany
- High-Field and Hybrid MR Imaging, University Hospital Essen, University Duisburg-Essen, Essen, Germany
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张 天, 刘 宇, 王 韦, 赵 德. [Research status and development of biodegradable zinc alloy as orthopedics implant]. Sheng Wu Yi Xue Gong Cheng Xue Za Zhi 2023; 40:589-594. [PMID: 37380401 PMCID: PMC10307599 DOI: 10.7507/1001-5515.202204077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 03/05/2023] [Indexed: 06/30/2023]
Abstract
Znic (Zn) alloys with good cytocompatibility and suitable degradation rate have been a kind of biodegradable metal with great potential for clinical applications. This paper summarizes the biological role of degradable Zn alloy as bone implant materials, discusses the mechanical properties of different Zn alloys and their advantages and disadvantages as bone implant materials, and analyzes the influence of different processing strategies (such as alloying and additive manufacturing) on the mechanical properties of Zn alloys. This paper provides systematic design approaches for biodegradable Zn alloys as bone implant materials in terms of the material selection, product processing, structural topology optimization, and assesses their application prospects with a view to better serve the clinic.
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Affiliation(s)
- 天蔚 张
- 大连交通大学 机械工程学院(辽宁大连 116028)College of Mechanical Engineering, Dalian Jiaotong University, Dalian, Liaoning 116028, P. R. China
- 大连大学附属中山医院 骨科(辽宁大连 116001)Department of Orthopedics, Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning 116001, P. R. China
| | - 宇宸 刘
- 大连交通大学 机械工程学院(辽宁大连 116028)College of Mechanical Engineering, Dalian Jiaotong University, Dalian, Liaoning 116028, P. R. China
| | - 韦丹 王
- 大连交通大学 机械工程学院(辽宁大连 116028)College of Mechanical Engineering, Dalian Jiaotong University, Dalian, Liaoning 116028, P. R. China
| | - 德伟 赵
- 大连交通大学 机械工程学院(辽宁大连 116028)College of Mechanical Engineering, Dalian Jiaotong University, Dalian, Liaoning 116028, P. R. China
- 大连大学附属中山医院 骨科(辽宁大连 116001)Department of Orthopedics, Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning 116001, P. R. China
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Xu X, Wang H, Shen L, Yang Q, Yang Y. Application and evaluation of fused deposition modeling technique in customized medical products. Int J Pharm 2023; 640:122999. [PMID: 37254286 DOI: 10.1016/j.ijpharm.2023.122999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 04/23/2023] [Accepted: 04/25/2023] [Indexed: 06/01/2023]
Abstract
The fused deposition modeling (FDM) technique has enormous potential for developing customized medical products with complicated structures. In this study, the application of the FDM technique to three medical products was investigated, and the risk factors affecting product quality were evaluated. For FDM-printed matrix and reservoir preparations, special attention should be paid to spacing width reduction and layered coating thickness. Therefore, spacing printing fidelity and interlayer bonding strength was established as unique indexes to characterize the effectiveness and safety of FDM-printed medicine. For FDM-printed orthopedic implants, layer height affected the dimensional deviation of surface morphology, which could be digitally evaluated. Moreover, internal structure affected the biomechanical behavior, which could be investigated using in silico simulation. The results reveal the broad application of FDM technology in customized medical products and might help to establish scientific and reasonable evaluation systems for them.
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Affiliation(s)
- Xiaocui Xu
- College of Pharmaceutical Science, Zhejiang University of Technology, Hangzhou, China
| | - Huihui Wang
- Department of Pharmacy, Tianjin Medical University General Hospital Airport Hospital, Tianjin, China
| | - Lian Shen
- College of Pharmaceutical Science, Zhejiang University of Technology, Hangzhou, China
| | - Qingliang Yang
- College of Pharmaceutical Science, Zhejiang University of Technology, Hangzhou, China
| | - Yan Yang
- College of Pharmaceutical Science, Zhejiang University of Technology, Hangzhou, China.
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Schrimpff C, Link E, Fisse T, Baumann E, Klimmt C. Communication matters when it comes to adverse events: Associations of adverse events during implant treatment with patients' communication quality and trust assessments. Patient Educ Couns 2023; 110:107675. [PMID: 36827880 DOI: 10.1016/j.pec.2023.107675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 02/06/2023] [Accepted: 02/13/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVES Because patients' trust in their physicians is a critical factor in improving health outcomes and patient response to adverse events, it is important to analyze the determinants of trust. One of these determinants is patient-centered communication. Because the occurrence of adverse events must be communicated to the patient, we asked whether the perceived quality of patient-physician communication acts as an isolating factor between adverse events and patient trust. METHODS We proposed and tested a structural equation model linking the occurrence of adverse events to the mediator patient-provider communication quality and to the outcome patient trust. The model was controlled for sociodemographic and health-related factors. We used online survey data from German implant patients (n = 1312), as implant treatment is associated with frequent adverse events such as infections. RESULTS Our results show that adverse events during implant treatment are associated with small but significantly lower trust levels. Patient-provider communication quality partially mediates this association. CONCLUSIONS Patient trust does not appear to be immune to deterioration from adverse events. Patient-provider communication plays a role in mitigating this association. PRACTICE IMPLICATIONS To improve the quality of care, attention should be paid to how adverse events are communicated in a patient-centered manner.
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Affiliation(s)
- Charlotte Schrimpff
- Hanover Center for Health Communication, University of Music, Drama & Media, Hanover, Germany.
| | - Elena Link
- Hanover Center for Health Communication, University of Music, Drama & Media, Hanover, Germany
| | - Tanja Fisse
- Hanover Center for Health Communication, University of Music, Drama & Media, Hanover, Germany
| | - Eva Baumann
- Hanover Center for Health Communication, University of Music, Drama & Media, Hanover, Germany
| | - Christoph Klimmt
- Hanover Center for Health Communication, University of Music, Drama & Media, Hanover, Germany
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Selles M, Slotman DJ, van Osch JAC, Nijholt IM, Wellenberg RHH, Maas M, Boomsma MF. Is AI the way forward for reducing metal artifacts in CT? development of a generic deep learning-based method and initial evaluation in patients with sacroiliac joint implants. Eur J Radiol 2023; 163:110844. [PMID: 37119708 DOI: 10.1016/j.ejrad.2023.110844] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 04/13/2023] [Accepted: 04/17/2023] [Indexed: 05/01/2023]
Abstract
PURPOSE To develop a deep learning-based metal artifact reduction technique (dl-MAR) and quantitatively compare metal artifacts on dl-MAR-corrected CT-images, orthopedic metal artifact reduction (O-MAR)-corrected CT-images and uncorrected CT-images after sacroiliac (SI) joint fusion. METHODS dl-MAR was trained on CT-images with simulated metal artifacts. Pre-surgery CT-images and uncorrected, O-MAR-corrected and dl-MAR-corrected post-surgery CT-images of twenty-five patients undergoing SI joint fusion were retrospectively obtained. Image registration was applied to align pre-surgery with post-surgery CT-images within each patient, allowing placement of regions of interest (ROIs) on the same anatomical locations. Six ROIs were placed on the metal implant and the contralateral side in bone lateral of the SI joint, the gluteus medius muscle and the iliacus muscle. Metal artifacts were quantified as the difference in Hounsfield units (HU) between pre- and post-surgery CT-values within the ROIs on the uncorrected, O-MAR-corrected and dl-MAR-corrected images. Noise was quantified as standard deviation in HU within the ROIs. Metal artifacts and noise in the post-surgery CT-images were compared using linear multilevel regression models. RESULTS Metal artifacts were significantly reduced by O-MAR and dl-MAR in bone (p < 0.001), contralateral bone (O-MAR: p = 0.009; dl-MAR: p < 0.001), gluteus medius (p < 0.001), contralateral gluteus medius (p < 0.001), iliacus (p < 0.001) and contralateral iliacus (O-MAR: p = 0.024; dl-MAR: p < 0.001) compared to uncorrected images. Images corrected with dl-MAR resulted in stronger artifact reduction than images corrected with O-MAR in contralateral bone (p < 0.001), gluteus medius (p = 0.006), contralateral gluteus medius (p < 0.001), iliacus (p = 0.017), and contralateral iliacus (p < 0.001). Noise was reduced by O-MAR in bone (p = 0.009) and gluteus medius (p < 0.001) while noise was reduced by dl-MAR in all ROIs (p < 0.001) in comparison to uncorrected images. CONCLUSION dl-MAR showed superior metal artifact reduction compared to O-MAR in CT-images with SI joint fusion implants.
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Affiliation(s)
- Mark Selles
- Department of Radiology, Isala, 8025 AB Zwolle, the Netherlands; Department of Radiology & Nuclear medicine, Amsterdam University Medical Centre, 1105 AZ Amsterdam, the Netherlands; Amsterdam Movement Sciences, 1081 BT Amsterdam, the Netherlands.
| | - Derk J Slotman
- Department of Radiology, Isala, 8025 AB Zwolle, the Netherlands
| | | | | | - Ruud H H Wellenberg
- Department of Radiology & Nuclear medicine, Amsterdam University Medical Centre, 1105 AZ Amsterdam, the Netherlands; Amsterdam Movement Sciences, 1081 BT Amsterdam, the Netherlands
| | - Mario Maas
- Department of Radiology & Nuclear medicine, Amsterdam University Medical Centre, 1105 AZ Amsterdam, the Netherlands; Amsterdam Movement Sciences, 1081 BT Amsterdam, the Netherlands
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11
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Chen X, Zhou J, Qian Y, Zhao L. Antibacterial coatings on orthopedic implants. Mater Today Bio 2023; 19:100586. [PMID: 36896412 PMCID: PMC9988588 DOI: 10.1016/j.mtbio.2023.100586] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 02/01/2023] [Accepted: 02/14/2023] [Indexed: 02/17/2023] Open
Abstract
With the aging of population and the rapid improvement of public health and medical level in recent years, people have had an increasing demand for orthopedic implants. However, premature implant failure and postoperative complications frequently occur due to implant-related infections, which not only increase the social and economic burden, but also greatly affect the patient's quality of life, finally restraining the clinical use of orthopedic implants. Antibacterial coatings, as an effective strategy to solve the above problems, have been extensively studied and motivated the development of novel strategies to optimize the implant. In this paper, a variety of antibacterial coatings recently developed for orthopedic implants were briefly reviewed, with the focus on the synergistic multi-mechanism antibacterial coatings, multi-functional antibacterial coatings, and smart antibacterial coatings that are more potential for clinical use, thereby providing theoretical references for further fabrication of novel and high-performance coatings satisfying the complex clinical needs.
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Affiliation(s)
- Xionggang Chen
- Institute of Physics & Optoelectronics Technology, Baoji Advanced Titanium Alloys and Functional Coatings Cooperative Innovation Center, Baoji University of Arts and Sciences, Baoji, 721016, PR China
| | - Jianhong Zhou
- Institute of Physics & Optoelectronics Technology, Baoji Advanced Titanium Alloys and Functional Coatings Cooperative Innovation Center, Baoji University of Arts and Sciences, Baoji, 721016, PR China
| | - Yu Qian
- Institute of Physics & Optoelectronics Technology, Baoji Advanced Titanium Alloys and Functional Coatings Cooperative Innovation Center, Baoji University of Arts and Sciences, Baoji, 721016, PR China
| | - LingZhou Zhao
- Department of Stomatology, Air Force Medical Center, The Fourth Military Medical University, Beijing, 100142, PR China
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12
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Liu D, Xi Y, Yu S, Yang K, Zhang F, Yang Y, Wang T, He S, Zhu Y, Fan Z, Du J. A polypeptide coating for preventing biofilm on implants by inhibiting antibiotic resistance genes. Biomaterials 2023; 293:121957. [PMID: 36549042 DOI: 10.1016/j.biomaterials.2022.121957] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 11/12/2022] [Accepted: 12/11/2022] [Indexed: 12/14/2022]
Abstract
Aging population has been boosting the need for orthopedic implants. However, biofilm has been a major obstacle for orthopedic implants due to its insensitivity to antibiotics and tendency to drive antimicrobial resistance. Herein, an antibacterial polypeptide coating with excellent in vivo adhesive capacity was prepared to prevent implants from forming biofilms and inducing acquired antibiotic resistance. A peptide-based copolymer, poly[phenylalanine10-stat-lysine12]-block-3,4-dihydroxy-l-phenylalanine [Poly(Phe10-stat-Lys12)-DOPA] was modularly designed, where poly(Phe10-stat-Lys12) is antibacterial polypeptide with high antibacterial activity, and DOPA provides strong adhesion in both wet and dry microenvironments. Meanwhile, compared to traditional "graft-onto" methods, this antibacterial coating can be facilely achieved by immersing Titanium substrates into antibacterial polypeptide solution for 5 min at room temperature. The poly(Phe10-stat-Lys12)-DOPA polymer showed good antibacterial activity with minimum inhibitory concentrations against S. aureus and E. coli of 32 and 400 μg/mL, respectively. Compared to obvious antimicrobial resistance of S. aureus after continuous treatment with vancomycin, this antibacterial coating doesn't drive antimicrobial resistance upon long-term utilization. Transcriptome sequencing and qPCR tests further confirmed that the antibacterial coating was able to inhibit the expression of multiple peptide resistance factor (mprF) and lipoteichoic acid modification D-alanylation genes (dltB and dltC) that can increase the net positive charge of bacterial cell wall to induce the resistance to cationic antimicrobial peptides. In vivo experiments confirmed that this poly(Phe10-stat-Lys12)-DOPA coating can both effectively prevent biofilm formation through surface contact sterilization and avoid local and systemic infections. Overall, we proposed a facile method for preparing antibacterial orthopedic implants with longer indwelling time and without inducing antimicrobial resistance by coating a polypeptide-based polymer on the implants.
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Affiliation(s)
- Danqing Liu
- Department of Orthopedics, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, 200072, China; Department of Polymeric Materials, School of Materials Science and Engineering, Tongji University, 4800 Caoan Road, Shanghai, 201804, China
| | - Yuejing Xi
- Department of Polymeric Materials, School of Materials Science and Engineering, Tongji University, 4800 Caoan Road, Shanghai, 201804, China
| | - Shunzhi Yu
- Department of Orthopedics, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, 200072, China
| | - Kexin Yang
- Department of Polymeric Materials, School of Materials Science and Engineering, Tongji University, 4800 Caoan Road, Shanghai, 201804, China
| | - Fan Zhang
- Department of Oral Implantology, Stomatological Hospital and Dental School of Tongji University, Shanghai Research Center of Tooth Restoration and Regeneration, Shanghai, 200072, China
| | - Yuying Yang
- Department of Polymeric Materials, School of Materials Science and Engineering, Tongji University, 4800 Caoan Road, Shanghai, 201804, China
| | - Tianlong Wang
- Department of Orthopedics, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, 200072, China
| | - Shisheng He
- Department of Orthopedics, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, 200072, China
| | - Yunqing Zhu
- Department of Orthopedics, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, 200072, China; Department of Polymeric Materials, School of Materials Science and Engineering, Tongji University, 4800 Caoan Road, Shanghai, 201804, China.
| | - Zhen Fan
- Department of Orthopedics, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, 200072, China; Department of Polymeric Materials, School of Materials Science and Engineering, Tongji University, 4800 Caoan Road, Shanghai, 201804, China.
| | - Jianzhong Du
- Department of Orthopedics, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, 200072, China; Department of Polymeric Materials, School of Materials Science and Engineering, Tongji University, 4800 Caoan Road, Shanghai, 201804, China.
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13
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Abstract
The total joint replacement is recognized as one of the most effective medical arbitrations leading to increased mobility, pain relief, and an overall restored function of the joint. Unfortunately, prosthetic debris accumulates after long-term wear of the implant leading to activation of the innate immune response and periprosthetic osteolysis. Understanding the intricate biological mechanisms underlying the innate immune response to implant debris would support the development of novel pharmacological treatments to prolong the life span of the implant. This article provides a detailed description on the role of the innate immune system in response to implant debris, emphasizing the most recent research and outstanding questions. Furthermore, a critical discussion is presented on the novel pharmacological treatments currently under investigation to prevent implant failure.
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Affiliation(s)
- Rajiv Supra
- College of Osteopathic Medicine, Touro University, Henderson, Nevada
| | - Devendra K Agrawal
- Department of Translational Research, Western University of Health Sciences, 309 E. Second Street, Pomona, California 91766-1854, USA
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14
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Alaña M, Lopez-Arancibia A, Ghouse S, Rodriguez-Florez N, Ruiz de Galarreta S. Additively manufactured lattice structures with controlled transverse isotropy for orthopedic porous implants. Comput Biol Med 2022; 150:105761. [PMID: 36126355 DOI: 10.1016/j.compbiomed.2022.105761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 05/31/2022] [Accepted: 06/18/2022] [Indexed: 11/26/2022]
Abstract
Additively manufactured lattice structures enable the design of tissue scaffolds with tailored mechanical properties, which can be implemented in porous biomaterials. The adaptation of bone to physiological loads results in anisotropic bone tissue properties which are optimized for site-specific loads; therefore, some bone sites are stiffer and stronger along the principal load direction compared to other orientations. In this work, a semi-analytical model was developed for the design of transversely isotropic lattice structures that can mimic the anisotropy characteristics of different types of bone tissue. Several design possibilities were explored, and a particular unit cell, which was best suited for additive manufacturing was further analyzed. The design of the unit cell was parameterized and in-silico analysis was performed via Finite Element Analysis. The structures were manufactured additively in metal and tested under compressive loads in different orientations. Finite element analysis showed good correlation with the semi-analytical model, especially for elastic constants with low relative densities. The anisotropy measured experimentally showed a variable accuracy, highlighting the deviations from designs to additively manufactured parts. Overall, the proposed model enables to exploit the anisotropy of lattice structures to design lighter scaffolds with higher porosity and increased permeability by aligning the scaffold with the principal direction of the load.
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Affiliation(s)
- Markel Alaña
- Department of Mechanical Engineering and Materials, Universidad de Navarra, TECNUN Escuela de Ingenieros, Paseo Manuel de Lardizabal, 13, 20018 San Sebastian, Spain.
| | - Aitziber Lopez-Arancibia
- Department of Mechanical Engineering and Materials, Universidad de Navarra, TECNUN Escuela de Ingenieros, Paseo Manuel de Lardizabal, 13, 20018 San Sebastian, Spain
| | - Shaaz Ghouse
- Department of Mechanical Engineering, Imperial College London, South Kensington London SW7 2AZ, UK
| | - Naiara Rodriguez-Florez
- Department of Mechanical Engineering and Materials, Universidad de Navarra, TECNUN Escuela de Ingenieros, Paseo Manuel de Lardizabal, 13, 20018 San Sebastian, Spain; IKERBASQUE, Basque Foundation for Science, Plaza Euskadi 5, 48009, Bilbao, Spain
| | - Sergio Ruiz de Galarreta
- Department of Mechanical Engineering and Materials, Universidad de Navarra, TECNUN Escuela de Ingenieros, Paseo Manuel de Lardizabal, 13, 20018 San Sebastian, Spain
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15
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Kouijzer IJE, Speijker LTD, Aarntzen EHJG, Rijnen WHC, Somford MP, Maat I, van Meer MPA, Oever JT, Gisolf EH. Clinically unsuspected orthopedic implants during S. aureus bacteremia do not require additional diagnostic work-up. Infection 2022; 51:743-747. [PMID: 36076049 DOI: 10.1007/s15010-022-01913-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 08/24/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE To assess the likelihood of occult infection in patients with clinically unsuspected orthopedic implants during Staphylococcus aureus bacteremia (SAB). METHODS In a retrospective study in two Dutch hospitals, we included all patients with SAB between 2013 and 2020 with one or more orthopedic implants in whom [18F]FDG-PET/CT was performed. The primary outcome was the percentage of patients who had an orthopedic implant-related infection by S. aureus. We also compared clinical parameters in patients with clinically suspected and unsuspected implants. RESULTS Fifty-five of 191 (29%) orthopedic implants in 118 SAB patients included had clinical signs of infection. Of all 136 unsuspected implants, 5 (3%, all arthroplasties), showed increased [18F]FDG uptake around the prosthesis on [18F]FDG-PET/CT. The clinical course of these patients without clinically overt infection or relapse of bacteremia during follow-up of a median of 48 months (range 0-48), however, argued against prosthetic joint infection. CONCLUSION Although orthopedic implants are evidently a risk factor for metastatic infection during SAB, the absence of clinical symptoms obviate the need of additional investigations or prolonged antibiotic treatment.
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Affiliation(s)
- Ilse J E Kouijzer
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands.
| | - L T D Speijker
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands
| | - E H J G Aarntzen
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, the Netherlands
| | - W H C Rijnen
- Department of Orthopaedics, Radboud University Medical Center, Nijmegen, the Netherlands
| | - M P Somford
- Department of Orthopaedics, Rijnstate Hospital, Arnhem, the Netherlands
| | - I Maat
- Department of Medical Microbiology and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, the Netherlands
| | - M P A van Meer
- Department of Medical Microbiology and Immunology, Rijnstate Hospital, Arnhem, the Netherlands
| | - J Ten Oever
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands
| | - E H Gisolf
- Department of Internal Medicine, Rijnstate Hospital, Arnhem, the Netherlands
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16
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Qian J, Zhang W, Chen Y, Zeng P, Wang J, Zhou C, Zeng H, Sang H, Huang N, Zhang H, Wan G. Osteogenic and angiogenic bioactive collagen entrapped calcium/zinc phosphates coating on biodegradable Zn for orthopedic implant applications. Biomater Adv 2022; 136:212792. [PMID: 35929323 DOI: 10.1016/j.bioadv.2022.212792] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 03/21/2022] [Accepted: 04/01/2022] [Indexed: 06/15/2023]
Abstract
Zinc is becoming one of the leading candidate materials for biodegradable orthopedic implants owing to its attractive properties in terms of degradation behavior and mechanical properties. However, the insufficient surface bio-activities postpone its clinical application. In this study, an organic-inorganic collagen entrapped calcium/zinc phosphates coating was constructed on Zn surface to lessen Zn2+ releasing rate and to leverage the surface osteogenic and angiogenic properties. Collagen molecules were immobilized onto Zn substrate and subsequently coordinated with calcium and zinc ions to promote the CaZnP inorganic phase growth, ensuing an intertwined collagen-CaZnP hybrid system. Consequently, the hybrid coating was highly coalesced and compact. Such high quality warranted the contained Zn2+ releasing in a tolerable rate favorable for cells viability. The collagen-CaZnP coated Zn showed remarkedly stronger osteogenicity as compared to the untreated Zn, ascertained by the MC3T3-E1 osteoblast cell proliferation and differentiation assays, such as alkaline phosphatase expression and calcium nodule formation results. In addition, this hybrid coating supported human umbilical vein endothelial cells (HUVECs) migration and tube formation. The enhanced osteogenic and angiogenic properties could be ascribed to the nature of collagen and calcium/zinc phosphate components, the hybrid micro/nano-structure as well as the ability of controlling the Zn2+ release of Zn substrate into a suitable concentration range. Our strategy provides a new avenue to surface modification of biodegradable metals for bone regenerative perspective.
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Affiliation(s)
- Junyu Qian
- Key Laboratory of Advanced Technologies of Materials, Ministry of Education, School of Materials Science and Engineering, Southwest Jiaotong University, Chengdu 610031, China
| | - Wentai Zhang
- Key Laboratory of Advanced Technologies of Materials, Ministry of Education, School of Materials Science and Engineering, Southwest Jiaotong University, Chengdu 610031, China
| | - Yingqi Chen
- National & Local Joint Engineering Research Centre of Orthopaedic Biomaterials, Department of Bone & Joint Surgery, Peking University Shenzhen Hospital, Shenzhen 518036, China.
| | - Peijie Zeng
- Key Laboratory of Advanced Technologies of Materials, Ministry of Education, School of Materials Science and Engineering, Southwest Jiaotong University, Chengdu 610031, China
| | - Jiale Wang
- Key Laboratory of Advanced Technologies of Materials, Ministry of Education, School of Materials Science and Engineering, Southwest Jiaotong University, Chengdu 610031, China
| | - Chao Zhou
- National United Engineering Laboratory for Biomedical Material Modification, Branden Industrial Park, Qihe Economic & Development Zone, Dezhou, Shandong 251100, China
| | - Hui Zeng
- National & Local Joint Engineering Research Centre of Orthopaedic Biomaterials, Department of Bone & Joint Surgery, Peking University Shenzhen Hospital, Shenzhen 518036, China
| | - Hongxun Sang
- Department of Orthopedics, Shenzhen Hospital of Southern Medical University, Shenzhen 518100, China
| | - Nan Huang
- Key Laboratory of Advanced Technologies of Materials, Ministry of Education, School of Materials Science and Engineering, Southwest Jiaotong University, Chengdu 610031, China
| | - Haijun Zhang
- National United Engineering Laboratory for Biomedical Material Modification, Branden Industrial Park, Qihe Economic & Development Zone, Dezhou, Shandong 251100, China; Department of Interventional and Vascular Surgery, The Tenth People's Hospital of Shanghai, Tongji University, Shanghai 200072, China.
| | - Guojiang Wan
- Key Laboratory of Advanced Technologies of Materials, Ministry of Education, School of Materials Science and Engineering, Southwest Jiaotong University, Chengdu 610031, China.
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Xiao L, Zhou YJ, Jiang YB, Tam MS, Cheang LH, Wang HJ, Zha ZG, Zheng XF. Effect of Diabetes Mellitus on Implant Osseointegration of Titanium Screws: An Animal Experimental Study. Orthop Surg 2022; 14:1217-1228. [PMID: 35451209 PMCID: PMC9163984 DOI: 10.1111/os.13274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 03/15/2022] [Accepted: 03/21/2022] [Indexed: 11/27/2022] Open
Abstract
Objective To explore the effect of diabetes mellitus (DM) on implant osseointegration of titanium screws. Methods Sixty rats were randomly divided into a DM group and a control group (each group, n = 30). DM group rats were injected with 1% Streptozotocin solution at 65 mg/kg to establish a DM model. Titanium screws were implanted into the rats' distal femurs in both groups. The rats were sacrificed for micro‐CT scanning, micro‐indentation, biomechanical detection, confocal Raman microspectroscopy, and histological and histomorphometric analysis at 4, 8, and 12 weeks post‐implantation, respectively. Messenger RNA (mRNA) expression and protein expression of the related growth factors around the implant were analyzed using real‐time polymerase chain reaction and Western blots. Results At 4, 8 and 12 weeks, micro‐CT scanning, hematoxylin‐eosin (HE) staining, Gieson's acid‐magenta staining, and fluorescent labeled staining showed disorder in the bone tissue arrangement, a lack of new bone tissue, poor maturity and continuity, and poor trabecular bone parameters around the implant in the DM group. At 4, 8, and 12 weeks, the interfacial bone binding rate in the DM group was significantly lower (16.2% ± 4.8%, 25.7% ± 5.7%, 42.5% ± 5.8%, respectively) than that in the control group (23.6% ± 5.2%, 40.8% ± 6.3%, 64.2% ± 7.3%, respectively; P < 0.05). At 8 and 12 weeks, the elastic modulus (17.0 ± 1.8 and 15.1 ± 1.5 GPa, respectively) and trabecular bone hardness (571 ± 39 and 401 ± 37 MPa, respectively) in the DM group were significantly lower than the elastic modulus (23.4 ± 2.3 and 23.8 ± 1.8 GPa, respectively) and trabecular bone hardness (711 ± 45 and 719 ± 46 MPa, respectively) in the control group (P < 0.05). The maximum load required for the prosthesis pull‐out experiment in the DM group at 4, 8, and 12 weeks (55.14 ± 6.74 N, 73.34 ± 8.43 N, and 83.45 ± 8.32 N, respectively) was significantly lower than that in the control group (77.45 ± 7.48 N, 93.28 ± 8.29 N, and 123.62 ± 9.43 N, respectively, P < 0.05). At 8 and 12 weeks, the mineral‐to‐collagen ratio in the DM group (6.56 % ± 1.35% and 4.45%± 1.25%, respectively) was significantly higher than that in the control group (5.31% ± 1.42% and 3.62% ± 1.33%, respectively, P < 0.05). At 12 weeks, mRNA and protein expression levels of bone morphogenetic protein 2, transforming growth factor‐β1, vascular endothelial growth factor, osteopontin, osteocalcin, and runt‐related transcription factor 2 in the DM group were significantly lower than that in the control group. Conclusions DM can negatively affect bone osseointegration, manifesting as disorder in bone tissue arrangement around the implant, a lack of new bone tissue, poor maturity and continuity, poor trabecular bone parameters and lower expression of the related growth factors.
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Affiliation(s)
- Lei Xiao
- Emergency Department, The First Affiliated Hospital, Jinan University, Guangzhou, China.,Department of Orthopaedic Surgery and Sports Medicine Center, The First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Yi-Juan Zhou
- Emergency Department, The First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Ya-Bin Jiang
- Emergency Department, The First Affiliated Hospital, Jinan University, Guangzhou, China
| | | | - Lek Hang Cheang
- Macau Medical Science and Technology Research Association, Macau, China
| | - Hua-Jun Wang
- Department of Orthopaedic Surgery and Sports Medicine Center, The First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Zhen-Gang Zha
- Department of Orthopaedic Surgery and Sports Medicine Center, The First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Xiao-Fei Zheng
- Department of Orthopaedic Surgery and Sports Medicine Center, The First Affiliated Hospital, Jinan University, Guangzhou, China
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Mazurek-Popczyk J, Palka L, Arkusz K, Dalewski B, Baldy-Chudzik K. Personalized, 3D- printed fracture fixation plates versus commonly used orthopedic implant materials- biomaterials characteristics and bacterial biofilm formation. Injury 2022; 53:938-46. [PMID: 34949461 DOI: 10.1016/j.injury.2021.12.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 12/07/2021] [Accepted: 12/07/2021] [Indexed: 02/06/2023]
Abstract
Additive manufacturing enabled the development of personalized, ideally fitting medical devices. The topography of the surface of the 3D-printed implant may not only facilitate its integration but also cause its rejection, as the surface may become a reservoir for different bacterial strains. In this study, the innovative, raw, 3D- printed fracture fixation plates, manufactured by using selective laser melting (SLM) from Ti-6Al-4V were compared with commercially available, surface-modified plates commonly used in orthopedic surgery. The topography surface of the plates was studied by atomic force microscopy. Susceptibility to the development of biofilm was tested for Staphylococcus epidermidis, Staphylococcus aureus and Streptococcus mutans by using crystal violet staining of biomass, confocal, and scanning electron microscopy (SEM). 3D- printed plates showed higher roughness (Sa=131.0 nm) than commercial plates (CP1 and CP2), Sa= 60.67 nm and Sa=55.48 nm, respectively. All strains of bacteria colonized 3D- printed raw plates more densely than commercial plates. The microscopic visualization showed biofilm mostly in irregular cavities of printed plates while on commercial plates it was mainly located along the edges. The research has indicated that there is need for further development of this technology to optimize its effectiveness and safety.
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19
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Radice S, Wimmer MA. Biotribometer for Assessment of Cell and Tissue Toxicity of Orthopedic Metal Implant Debris. Methods Mol Biol 2022; 2394:713-725. [PMID: 35094354 DOI: 10.1007/978-1-0716-1811-0_37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
A novel approach to address the clinical issue of cell response to wear and corrosion debris from metal orthopedic implants consists of combining cell culturing with wear and corrosion debris generation. A biotribometer equipped with a three-electrode electrochemical chamber operates inside a CO2 incubator. Cells are cultured at the bottom of the chamber. A ceramic ball (hip implant head) is pressed against a metal disc under a constant load, and set in reciprocating rotation. An anodic electrochemical potential can be applied to a metal disc for accelerated corrosion conditions, or the free potential may be monitored.Measurements of gravimetric and volumetric material loss of the metal disc postwear provide quantitative information that can be put in relation to biological assays (e.g., cell viability and secretion of proinflammatory cytokines). This approach allows for the comparison of candidate metals potentially undergoing tribocorrosion in clinical use. The approach allows to identify the effect of any metastable debris, likely active in vivo.
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Affiliation(s)
- Simona Radice
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Markus A Wimmer
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA.
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Sabino RM, Rau JV, De Bonis A, De Stefanis A, Curcio M, Teghil R, Popat KC. Manganese-containing Bioactive Glass Enhances Osteogenic Activity of TiO 2 Nanotube Arrays. Appl Surf Sci 2021; 570:151163. [PMID: 34594060 PMCID: PMC8478254 DOI: 10.1016/j.apsusc.2021.151163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Titanium and its alloys are the most used biomaterials for orthopedic and dental applications. However, up to 10% of these medical devices still fail, mostly due to implant loosening and suboptimal integration at the implant site. The biomaterial surface plays a critical role in promoting osseointegration, which can reduce the risk of device failure. In this study, we propose a novel surface modification on titanium to improve osteogenic differentiation by depositing manganese-containing bioactive glass (BG) on TiO2 nanotube arrays. The surfaces were characterized by scanning electron microscopy, energy dispersive X-ray spectrometer, contact angle goniometry, and X-ray photoelectron spectroscopy. Cell toxicity, viability, adhesion, and proliferation of adipose-derived stem cells on the surfaces were investigated up to 7 days. To evaluate the osteogenic properties of the surfaces, alkaline phosphatase activity, total protein, osteocalcin expression, and calcium deposition were quantified up to 28 days. The results indicate that TiO2 nanotube arrays modified with BG promote cell growth and induce increased osteocalcin and calcium contents when compared to unmodified TiO2 nanotube arrays. The deposition of manganese-containing bioactive glass onto TiO2 nanotubes demonstrates the ability to enhance osteogenic activity on titanium, showing great potential for use in orthopedic and dental implants.
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Affiliation(s)
- Roberta M. Sabino
- School of Advanced Materials Discovery, Colorado State University, Fort Collins, USA
| | - Julietta V. Rau
- Istituto di Struttura della Materia, Consiglio Nazionale delle Ricerche (ISM-CNR), Via del Fosso del Cavaliere 100, 00133 Rome, Italy
- I.M. Sechenov First Moscow State Medical University, Institute of Pharmacy, Department of Analytical, Physical and Colloid Chemistry, Trubetskaya 8, build. 2, 119991 Moscow, Russia
| | - Angela De Bonis
- Dipartimento di Scienze, Università della Basilicata, Via dell’Ateneo Lucano, 10-85100 Potenza, Italy
| | - Adriana De Stefanis
- Istituto di Struttura della Materia, Consiglio Nazionale delle Ricerche (ISM-CNR), Montelibretti Unit, Via Salaria km 29.300, 00015 Monterotondo Scalo, Italy
| | - Mariangela Curcio
- Dipartimento di Scienze, Università della Basilicata, Via dell’Ateneo Lucano, 10-85100 Potenza, Italy
| | - Roberto Teghil
- Dipartimento di Scienze, Università della Basilicata, Via dell’Ateneo Lucano, 10-85100 Potenza, Italy
| | - Ketul C. Popat
- School of Advanced Materials Discovery, Colorado State University, Fort Collins, USA
- School of Biomedical Engineering, Colorado State University, Fort Collins, USA
- Department of Mechanical Engineering, Colorado State University, Fort Collins, USA
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Lee MK, Lee H, Park C, Kang IG, Kim J, Kim HE, Jung HD, Jang TS. Accelerated biodegradation of iron-based implants via tantalum-implanted surface nanostructures. Bioact Mater 2022; 9:239-50. [PMID: 34820568 DOI: 10.1016/j.bioactmat.2021.07.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 04/28/2021] [Accepted: 07/03/2021] [Indexed: 12/18/2022] Open
Abstract
In recent years, pure iron (Fe) has attracted significant attention as a promising biodegradable orthopedic implant material due to its excellent mechanical and biological properties. However, in physiological conditions, Fe has an extremely slow degradation rate with localized and irregular degradation, which is problematic for practical applications. In this study, we developed a novel combination of a nanostructured surface topography and galvanic reaction to achieve uniform and accelerated degradation of an Fe implant. The target-ion induced plasma sputtering (TIPS) technique was applied on the Fe implant to introduce biologically compatible and electrochemically noble tantalum (Ta) onto its surface and develop surface nano-galvanic couples. Electrochemical tests revealed that the uniformly distributed nano-galvanic corrosion cells of the TIPS-treated sample (nano Ta–Fe) led to relatively uniform and accelerated surface degradation compared to that of bare Fe. Furthermore, the mechanical properties of nano Ta–Fe remained almost constant during a long-term in vitro immersion test (~40 weeks). Biocompatibility was also assessed on surfaces of bare Fe and nano Ta–Fe using in vitro osteoblast responses through direct and indirect contact assays and an in vivo rabbit femur medullary cavity implantation model. The results revealed that nano Ta–Fe not only enhanced cell adhesion and spreading on its surface, but also exhibited no signs of cellular or tissue toxicity. These results demonstrate the immense potential of Ta-implanted surface nanostructures as an effective solution for the practical application of Fe-based orthopedic implants, ensuring long-term biosafety and clinical efficacy. The degradation rate of nanostructured Fe implants was accelerated by TIPS technique. Ta ions were accelerated strongly toward the Fe surface by TIPS process. Nano Ta–Fe showed long-term mechanical stability and accelerated degradation rate. Nanostructured Ta–Fe surface showed enhanced in vitro and in vivo cellular responses. Ta-implanted Fe is a promising material for biodegradable orthopedic implants.
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Abstract
Imaging of metal implants has historically been difficult, regardless of the applied modality. The number of primary arthroplasties is increasing over the years. With it, we expect the number of symptomatic complications to increase as well. Acquiring accurate imaging for diagnosis and treatment planning for these cases is of paramount importance. Significant advancements have been made to reduce artifacts, leading to better imaging representation of arthroplasty. This review article would give a background on the current ways of imaging arthroplasty and metal implants, covering recent advances in imaging techniques.
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Affiliation(s)
| | | | - Ankit Tandon
- Tan Tock Seng Hospital, Singapore
- Corresponding author.
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Manivasagam VK, Popat KC. Hydrothermally treated titanium surfaces for enhanced osteogenic differentiation of adipose derived stem cells. Mater Sci Eng C Mater Biol Appl 2021; 128:112315. [PMID: 34474866 DOI: 10.1016/j.msec.2021.112315] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 06/20/2021] [Accepted: 07/07/2021] [Indexed: 02/07/2023]
Abstract
Implant surface plays a crucial role in improving osseointegration and long-term implant life. When the implant comes in contact with the bone tissue, the bone marrow mesenchymal cells interact with the implant surface and the surface properties such as morphology, wettability, mechanical properties and chemistry influences cell migration, proliferation and differentiation. Different surface modification strategies such as ceramic coatings, surface dealloying, and surface topography modifications for improving osteointegration have been investigated. However, studies have not yet established which of the surface property is more influential. In this study, titanium surfaces were treated hydrothermally with sodium hydroxide and sulfuric acid separately. This treatment led to the development of two unique surface topography at nanoscale. These modified surfaces were characterized for surface morphology, wettability, chemistry, and crystallinity. Cytotoxicity, cell adhesion, proliferation, morphology, and differentiation of adipose derived stem cells on modified surfaces was investigated. The results indicate that wettability does influence initial cell adhesion. However, the surface morphology can play major role in cell spreading, proliferation and differentiation. The results indicate that titanium surfaces treated hydrothermally with sodium hydroxide led to a nanoporous architecture that promoted appropriate cell interaction with the surface promoting osteoblastic lineage.
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Affiliation(s)
- Vignesh K Manivasagam
- Department of Mechanical Engineering, Colorado State University, Fort Collins, CO 80523, USA
| | - Ketul C Popat
- Department of Mechanical Engineering, Colorado State University, Fort Collins, CO 80523, USA; School of Biomedical Engineering, Colorado State University, Fort Collins, CO 80523, USA; School of Advanced Materials Discovery, Colorado State University, Fort Collins, CO 80523, USA.
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Wu N, Li S, Zhang B, Wang C, Chen B, Han Q, Wang J. The advances of topology optimization techniques in orthopedic implants: A review. Med Biol Eng Comput 2021; 59:1673-89. [PMID: 34363576 DOI: 10.1007/s11517-021-02361-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Accepted: 04/05/2021] [Indexed: 10/20/2022]
Abstract
Metal implants are widely used in the treatment of orthopedic diseases. However, owing to the mismatched elastic modulus of the bone and implants, stress shielding often occurs clinically which can result in failure of the implant or fractures around the implant. Topology optimization (TO) is a technique that can provide more efficient material distribution according to the objective function under the special load and boundary conditions. Several researchers have paid close attention to TO for optimal design of orthopedic implants. Thanks to the development of additive manufacturing (AM), the complex structure of the TO design can be fabricated. This article mainly focuses on the current stage of TO technique with respect to the global layout and hierarchical structure in orthopedic implants. In each aspect, diverse implants in different orthopedic fields related to TO design are discussed. The characteristics of implants, methods of TO, validation methods of the newly designed implants, and limitations of current research have been summarized. The review concludes with future challenges and directions for research. Wang TO design of global layout and local structure of implants in diverse fields of orthopedic.
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Shelly S, Liraz Zaltsman S, Ben-Gal O, Dayan A, Ganmore I, Shemesh C, Atrakchi D, Garra S, Ravid O, Rand D, Israelov H, Alon T, Lichtenstein G, Sharabi S, Last D, Gosselet F, Rosen V, Burstein G, Friedlander A, Harel R, Vogel G, Schnaider Beeri M, Mardor Y, Lampl Y, Fleminger G, Cooper I. Potential neurotoxicity of titanium implants: Prospective, in-vivo and in-vitro study. Biomaterials 2021; 276:121039. [PMID: 34352627 DOI: 10.1016/j.biomaterials.2021.121039] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 07/14/2021] [Accepted: 07/21/2021] [Indexed: 02/08/2023]
Abstract
Titanium dioxide (TiO2) is a frequently used biomaterial, particularly in orthopedic and dental implants, and it is considered an inert and benign compound. This has resulted in toxicological scrutiny for TiO2 in the past decade, with numerus studies showing potential pathologic downstream effects. Herein we describe case report of a 77-year-old male with subacute CNS dysfunction, secondary to breakdown of a titanium-based carotid stent and leading to blood levels 1000 times higher (3 ppm) than the reported normal. We prospectively collected tissues adjacent to orthopedic implants and found a positive correlation between titanium concentration and time of implant in the body (r = 0.67, p < 0.02). Rats bearing titanium implants or intravascularly treated with TiO2 nanoparticles (TiNP) exhibited memory impairments. A human blood-brain barrier (BBB) in-vitro model exposed to TiNP showed paracellular leakiness, which was corroborated in-vivo with the decrease of key BBB transcripts in isolated blood vessels from hippocampi harvested from TiNP-treated mice. Titanium particles rapidly internalized into brain-like endothelial cells via caveolae-mediated endocytosis and macropinocytosis and induced pro-inflammatory reaction with increased expression of pro-inflammatory genes and proteins. Immune reaction was mediated partially by IL-1R and IL-6. In summary, we show that high levels of titanium accumulate in humans adjacent to orthopedic implants, and our in-vivo and in-vitro studies suggest it may be neurotoxic.
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Affiliation(s)
- Shahar Shelly
- Department of Neurology, College of Medicine, Mayo Clinic Rochester, Minnesota, USA
| | - Sigal Liraz Zaltsman
- The Joseph Sagol Neuroscience Center, Sheba Medical Center, Israel; Department of Pharmacology, The Institute for Drug Research, The Hebrew University of Jerusalem, Jerusalem, Israel; Institute for Health and Medical Professions, Department of Sports Therapy, Ono Academic College, Kiryat Ono, Israel
| | - Ofir Ben-Gal
- Department of Orthopedic, Sheba Medical Center, Tel Hashomer, 52621, Israel
| | - Avraham Dayan
- The Shmunis School of Biomedicine and Cancer Research, The George Wise Faculty of Life Sciences, Tel Aviv University, Ramat Aviv, Israel
| | - Ithamar Ganmore
- The Joseph Sagol Neuroscience Center, Sheba Medical Center, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Department of Neurology, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Chen Shemesh
- The Joseph Sagol Neuroscience Center, Sheba Medical Center, Israel
| | - Dana Atrakchi
- The Joseph Sagol Neuroscience Center, Sheba Medical Center, Israel
| | - Sharif Garra
- Department of Orthopedic, Sheba Medical Center, Tel Hashomer, 52621, Israel
| | - Orly Ravid
- The Joseph Sagol Neuroscience Center, Sheba Medical Center, Israel
| | - Daniel Rand
- The Joseph Sagol Neuroscience Center, Sheba Medical Center, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Hila Israelov
- The Joseph Sagol Neuroscience Center, Sheba Medical Center, Israel
| | - Tayir Alon
- Neurology Department, Rabin Medical Center - Beilinson Hospital, Petach Tikva, 4941492, Israel
| | | | - Shirley Sharabi
- The Advanced Technology Center, Sheba Medical Center, Ramat-Gan, 52621, Israel
| | - David Last
- The Advanced Technology Center, Sheba Medical Center, Ramat-Gan, 52621, Israel
| | - Fabien Gosselet
- Univ. Artois, UR 2465, Blood-brain Barrier Laboratory (LBHE), F-62300 Lens, France
| | - Vasiliy Rosen
- The ICP Unit, The Core Facility of the Faculty of Agriculture, Food and Environment, The Hebrew University of Jerusalem, Rehovot, 7610001, Israel
| | | | - Alon Friedlander
- Spine Surgery Division, Department of Orthopedics, Sheba Medical Center, Israel
| | - Ran Harel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Spine Surgery Division, Department of Neurosurgery, Sheba Medical Center, Israel
| | - Guy Vogel
- Department of Orthopedic, Sheba Medical Center, Tel Hashomer, 52621, Israel
| | - Michal Schnaider Beeri
- The Joseph Sagol Neuroscience Center, Sheba Medical Center, Israel; School of Psychology, Interdisciplinary Center (IDC), Herzliya, Israel; Department of Psychiatry, The Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Yael Mardor
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel; The Advanced Technology Center, Sheba Medical Center, Ramat-Gan, 52621, Israel
| | - Yair Lampl
- Department of Neurology, Wolfson Medical Center, Holon, Israel
| | - Gideon Fleminger
- The Shmunis School of Biomedicine and Cancer Research, The George Wise Faculty of Life Sciences, Tel Aviv University, Ramat Aviv, Israel
| | - Itzik Cooper
- The Joseph Sagol Neuroscience Center, Sheba Medical Center, Israel; School of Psychology, Interdisciplinary Center (IDC), Herzliya, Israel; The Nehemia Rubin Excellence in Biomedical Research - The TELEM Program, Sheba Medical Center, Tel-Hashomer, Israel.
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Liu Y, Su Y, Cui Z, Guo Y, Zhang W, Wu J. Clinical and microbiological features of anaerobic implant-related infection in 80 patients after orthopedic surgery. Anaerobe 2021; 71:102413. [PMID: 34229056 DOI: 10.1016/j.anaerobe.2021.102413] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 07/01/2021] [Accepted: 07/03/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVES Implant-related infection is a common complication after orthopedic surgery, but there is limited research focused on anaerobic infections. We retrospectively analyzed data from 80 patients with anaerobic implant-related infections in order to investigate the clinical features, bacterial distribution and antimicrobial resistant characteristics of this disease. METHODS 80 patients who underwent implant-related infections with anaerobes were included. Pathogens were isolated and identified by matrix-assisted laser desorption ionization time-of-flight (MALDI-TOF) mass spectrometry with verification of 16s rRNA sequencing. Antimicrobial susceptibility testing (AST) was performed using Epsilometric test (E-test). RESULTS Among the 80 patients, 61.2% (49/80) were infected with anaerobes alone, while 38.8% (31/80) were co-infected with anaerobes and other bacteria. Early infection cases involving anaerobe-alone infections were significantly higher compared to the co-infection group (P < 0.001), also exhibiting lower levels of neutrophils (P = 0.033) and ESR (P = 0.046). Anaerobe-alone infections in the prosthetic joint infection group represented a higher proportion compared with other implant-related infections (P = 0.031). Among all species of anaerobes identified, the top 3 were Cutibacterium acnes, Finegoldia magna and Peptostreptococcus anaerobius. Low MIC values to vancomycin was recorded in C. acnes strains and for amoxicillin/clavulanic acid and piperacillin/tazobactam in most F. magna strains. One of the C. acnes and F. magna strains appeared multi-drug resistant except to vancomycin. CONCLUSIONS Anaerobe-alone infections have later first onset times and lower infection biomarker levels compared to co-infected patients. The first choice against C. acnes is vancomycin, while amoxicillin/clavulanic acid and piperacillin/tazobactam are recommended for F. magna.
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Wang K, Jin H, Song Q, Huo J, Zhang J, Li P. Titanium dioxide nanotubes as drug carriers for infection control and osteogenesis of bone implants. Drug Deliv Transl Res 2021; 11:1456-74. [PMID: 33942245 DOI: 10.1007/s13346-021-00980-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2021] [Indexed: 02/07/2023]
Abstract
Titanium implants have been widely used as one of the most effective treatments of bone defects. However, the lack of osteogenesis and bacteria-resistant activities result in high infection and loosening rates of titanium implants. Anodic oxidation could easily construct titanium dioxide nanotubes (TNTs) array on the surface of titanium, and the rough surface of TNTs is beneficial to the growth of osteoblast-related cells on the surface. And TNTs could be excellent drug carriers because of their single-entry tubular hollow structure. In this review, we aim at detailing the application of TNTs as drug carriers in the field of bone implants. Starting from the topography of TNTs, we illustrated the biological activity of the TNTs surface, the drugs for loading in TNTs, and the controlled and responsive release strategies of drug-loaded TNTs, respectively. At the end of this review, the shortcomings of TNTs as the drug carrier in the field of bone implants are discussed, and the development direction of this research field is also prospected.
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Mohammadtaheri M, Li Y, Yang Q. Hard Cr 2O 3 coatings on SS316L substrates prepared by reactive magnetron sputtering technique: a potential candidate for orthopedic implants. Environ Sci Pollut Res Int 2021; 28:25146-25154. [PMID: 31001781 DOI: 10.1007/s11356-019-05006-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 03/26/2019] [Indexed: 06/09/2023]
Abstract
316L stainless steel (SS) implants suffer from tribological and biocompatibility problems which limit their service lifetime. In order to improve the surface properties of 316L SS for orthopedic implant applications, hard chromium oxide coatings were applied on 316L SS substrates using a reactive magnetron sputtering technique. The morphological, structural, and phase compositional analyses were conducted on the deposited coatings by scanning electron microscopy, X-ray diffraction, Raman spectroscopy, and X-ray photoelectron spectroscopy. The Rockwell-C indentation tests were performed on the coated substrates to qualitatively evaluate the adhesion of coatings on the steel substrates. The surface characteristics of coatings were measured by using an optical profilometer. The mechanical properties of coatings were reported by measuring the Hardness and Young's modulus. The corrosion resistance of coated and uncoated SS substrates was compared using potentiodynamic polarization tests. An inductively coupled plasma optical emission spectrometry (ICP-OES) was employed to analyze the biocompatibility of the samples by measuring the amount of toxic Cr ions released after the immersion test. The results show that the coatings are adherent and composed of a single Cr2O3 phase with a hardness of 25 to 29 GPa. The corrosion resistance of the SS has been improved by applying a chromium oxide coating. The coated SS samples have also demonstrated better wear resistance and lower friction coefficient compared to bare SS samples under a reciprocating sliding condition in saline solution. The biocompatibility of the SS has been enhanced by the Cr2O3 coating as much less Cr ions were released after immersion tests. These results indicate that the hard Cr2O3 coatings can be considered as a candidate for extending the lifetime of SS implants.
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Affiliation(s)
- Masoud Mohammadtaheri
- Department of Mechanical Engineering, University of Saskatchewan, 57 Campus Drive, Saskatoon, SK, S7H 5A9, Canada
| | - Yuanshi Li
- Department of Mechanical Engineering, University of Saskatchewan, 57 Campus Drive, Saskatoon, SK, S7H 5A9, Canada
| | - Qiaoqin Yang
- Department of Mechanical Engineering, University of Saskatchewan, 57 Campus Drive, Saskatoon, SK, S7H 5A9, Canada.
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Zhang Y, Attarilar S, Wang L, Lu W, Yang J, Fu Y. A Review on Design and Mechanical Properties of Additively Manufactured NiTi Implants for Orthopedic Applications. Int J Bioprint 2021; 7:340. [PMID: 33997434 PMCID: PMC8114098 DOI: 10.18063/ijb.v7i2.340] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 03/10/2021] [Indexed: 11/23/2022] Open
Abstract
NiTi alloy has a wide range of applications as a biomaterial due to its high ductility, low corrosion rate, and favorable biocompatibility. Although Young’s modulus of NiTi is relatively low, it still needs to be reduced; one of the promising ways is by introducing porous structure. Traditional manufacturing processes, such as casting, can hardly produce complex porous structures. Additive manufacturing (AM) is one of the most advanced manufacturing technologies that can solve impurity issues, and selective laser melting (SLM) is one of the well-known methods. This paper reviews the developments of AM-NiTi with a particular focus on SLM-NiTi utilization in biomedical applications. Correspondingly, this paper aims to describe the three key factors, including powder preparation, processing parameters, and gas atmosphere during the overall process of porous NiTi. The porous structure design is of vital importance, so the unit cell and pore parameters are discussed. The mechanical properties of SLM-NiTi, such as hardness, compressive strength, tensile strength, fatigue behavior, and damping properties and their relationship with design parameters are summarized. In the end, it points out the current challenges. Considering the increasing application of NiTi implants, this review paper may open new frontiers for advanced and modern designs.
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Affiliation(s)
- Yintao Zhang
- State Key Laboratory of Metal Matrix Composites, School of Materials Science and Engineering, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Shokouh Attarilar
- State Key Laboratory of Metal Matrix Composites, School of Materials Science and Engineering, Shanghai Jiao Tong University, Shanghai 200240, China.,Department of Pediatric Orthopaedics, Xinhua Hospital Affiliated to Shanghai Jiao Tong University, School of Medicine, Shanghai 200092, China
| | - Liqiang Wang
- State Key Laboratory of Metal Matrix Composites, School of Materials Science and Engineering, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Weijie Lu
- State Key Laboratory of Metal Matrix Composites, School of Materials Science and Engineering, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Junlin Yang
- Department of Pediatric Orthopaedics, Xinhua Hospital Affiliated to Shanghai Jiao Tong University, School of Medicine, Shanghai 200092, China
| | - Yuanfei Fu
- Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200011, China
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30
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Dan CP, Dan SI, Silaşi AAD, Tomoaia G. Immunologic reactions to bone and articular implants. Int Orthop 2021; 45:1941-1946. [PMID: 33797580 DOI: 10.1007/s00264-021-04977-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 02/02/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND In recent years the number on implantable devices that have been used in orthopedic surgeries has increased exponentially. As the number of people with orthopedic implants has grown, implant failure has become an increasingly important public health issue. While a significant percent of joint implants fails at between 15 and 20 years some authors suggest that one of the main causes is the interaction between the immune system of the host and the material of the implant METHODS: The search engines used for research comprised of PubMed, Google Scholar and Cochrane Library. RESULTS This review aims to summarize relevant and recent data on the immune reactions that are taking place at the juxtaposition between the implant and the patient's tissue, the time frame in which these immune reactions take place and some of the factors that can influence this reaction. The immune reactions can be divided into: hyperacute immune reactions (anaphylactic shock), acute reactions, the transition between the acute phase and the chronic phase and last but not least chronic immune reactions to such implants. CONCLUSION The research being done with regard to implant-related immunology strives to help in solving the problem of long-term implant failure.
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Affiliation(s)
- Cristian Paul Dan
- Department of Orthopedics and Traumatology, Iuliu Hatieganu University of Medicine and Pharmacy, 47 Gen. Traian Mosoiu Street, 400132, Cluj-Napoca, Romania.
| | - Simona Irina Dan
- Department of Physical Medicine and Rehabilitation, Clinical Recovery Hospital Cluj-Napoca, Strada Viilor nr 46-50, Cluj Napoca, 400437, Romania
| | - Adrian Alexandru Dorin Silaşi
- Department of Medical Oncology, The Oncology Institute Prof. Dr. Ion Chiricuţă Cluj-Napoca, 34-36 Republicii Street, 400015, Cluj-Napoca, Romania
| | - Gheorghe Tomoaia
- Department of Orthopedics and Traumatology, Iuliu Hatieganu University of Medicine and Pharmacy, 47 Gen. Traian Mosoiu Street, 400132, Cluj-Napoca, Romania.,Academy of Romanian Scientists, Splaiul Independenţei, nr. 54, Bucharest, Romania
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31
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McNamara SL, McCarthy EM, Schmidt DF, Johnston SP, Kaplan DL. Rheological characterization, compression, and injection molding of hydroxyapatite-silk fibroin composites. Biomaterials 2021; 269:120643. [PMID: 33434713 DOI: 10.1016/j.biomaterials.2020.120643] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 12/17/2020] [Accepted: 12/28/2020] [Indexed: 01/28/2023]
Abstract
Traditional bone fixation devices made from inert metal alloys provide structural strength for bone repair but are limited in their ability to actively promote bone healing. Although several naturally derived bioactive materials have been developed to promote ossification in bone defects, it is difficult to translate small-scale benchtop fabrication of these materials to high-output manufacturing. Standard industrial molding processes, such as injection and compression molding, have typically been limited to use with synthetic polymers since most biopolymers cannot withstand the harsh processing conditions involved in these techniques. Here we demonstrate injection and compression molding of a bioceramic composite comprised of hydroxyapatite (HA) and silk fibroin (SF) from Bombyx mori silkworm cocoons. Both the molding behavior of the HA-SF slurry and final scaffold mechanics can be controlled by modulating SF protein molecular weight, SF content, and powder-to-liquid ratio. HA-SF composites with up to 20 weight percent SF were successfully molded into stable three-dimensional structures using high pressure molding techniques. The unique durability of silk fibroin enables application of common molding techniques to fabricate composite silk-ceramic scaffolds. This work demonstrates the potential to move bone tissue engineering one step closer to large-scale manufacturing of natural protein-based resorbable bone grafts and fixation devices.
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Affiliation(s)
- Stephanie L McNamara
- Department of Biomedical Engineering, Tufts University, Medford, MA, USA; Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA.
| | - Ethan M McCarthy
- Department of Plastics Engineering, University of Massachusetts Lowell, Lowell, MA, USA.
| | - Daniel F Schmidt
- Department of Plastics Engineering, University of Massachusetts Lowell, Lowell, MA, USA.
| | - Stephen P Johnston
- Department of Plastics Engineering, University of Massachusetts Lowell, Lowell, MA, USA.
| | - David L Kaplan
- Department of Biomedical Engineering, Tufts University, Medford, MA, USA.
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Sabino RM, Mondini G, Kipper MJ, Martins AF, Popat KC. Tanfloc/heparin polyelectrolyte multilayers improve osteogenic differentiation of adipose-derived stem cells on titania nanotube surfaces. Carbohydr Polym 2021; 251:117079. [PMID: 33142622 PMCID: PMC7717535 DOI: 10.1016/j.carbpol.2020.117079] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 08/22/2020] [Accepted: 09/07/2020] [Indexed: 01/11/2023]
Abstract
In this study, a surface modification strategy using natural biopolymers on titanium is proposed to improve bone healing and promote rapid and successful osseointegration of orthopedic implants. Titania nanotubes were fabricated via an anodization process and the surfaces were further modified with polyelectrolyte multilayers (PEMs) based on Tanfloc (a cationic tannin derivative) and glycosaminoglycans (heparin and hyaluronic acid). Scanning electron microscopy (SEM), water contact angle measurements, and X-ray photoelectron spectroscopy were used to characterize the surfaces. Adipose-derived stem cells (ADSCs) were seeded on the surfaces, and the cell viability, adhesion, and proliferation were investigated. Osteogenesis was induced and osteogenic differentiation of human ADSCs on the surfaces was evaluated via mineralization and protein expression assays, immunofluorescent staining, and SEM. The Tanfloc/heparin PEMs on titania nanotubes improved the rate of osteogenic differentiation of ADSCs as well as the bone mineral deposition, and is therefore a promising approach for use in orthopedic implants.
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Affiliation(s)
- Roberta M Sabino
- School of Advanced Materials Discovery, Colorado State University, USA
| | - Gabriela Mondini
- Department of Biological Sciences, Pontifícia Universidade Católica do Paraná, Brazil
| | - Matt J Kipper
- School of Advanced Materials Discovery, Colorado State University, USA; School of Biomedical Engineering, Colorado State University, USA; Department of Chemical and Biological Engineering, Colorado State University, USA.
| | - Alessandro F Martins
- Department of Chemical and Biological Engineering, Colorado State University, USA; Laboratory of Materials, Macromolecules and Composites, Federal University of Technology, Brazil; Group of Polymers and Composite Materials, Chemical Department, State University of Maringá, Brazil
| | - Ketul C Popat
- School of Advanced Materials Discovery, Colorado State University, USA; School of Biomedical Engineering, Colorado State University, USA; Department of Mechanical Engineering, Colorado State University, USA.
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Zhao DW, Zuo KQ, Wang K, Sun ZY, Lu YP, Cheng L, Xiao GY, Liu C. Interleukin-4 assisted calcium-strontium-zinc-phosphate coating induces controllable macrophage polarization and promotes osseointegration on titanium implant. Mater Sci Eng C Mater Biol Appl 2021; 118:111512. [PMID: 33255069 DOI: 10.1016/j.msec.2020.111512] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 08/20/2020] [Accepted: 09/04/2020] [Indexed: 12/12/2022]
Abstract
Titanium (Ti) and its alloys are believed to be promising scaffold materials for dental and orthopedic implantation due to their ideal mechanical properties and biocompatibility. However, the host immune response always causes implant failures in the clinic. Surface modification of the Ti scaffold is an important factor in this process and has been widely studied to regulate the host immune response and to further promote bone regeneration. In this study, a calcium-strontium-zinc-phosphate (CSZP) coating was fabricated on a Ti implant surface by phosphate chemical conversion (PCC) technique, which modified the surface topography and element constituents. Here, we envisioned an accurate immunomodulation strategy via delivery of interleukin (IL)-4 to promote CSZP-mediated bone regeneration. IL-4 (0 and 40 ng/mL) was used to regulate immune response of macrophages. The mechanical properties, biocompatibility, osteogenesis, and anti-inflammatory properties were evaluated. The results showed that the CSZP coating exhibited a significant enhancement in surface roughness and hydrophilicity, but no obvious changes in proliferation or apoptosis of bone marrow mesenchymal stem cells (BMMSCs) and macrophages. In vitro, the mRNA and protein expression of osteogenic related factors in BMMSCs cultured on a CSZP coating, such as ALP and OCN, were significantly higher than those on bare Ti. In vivo, there was no enhanced bone formation but increased macrophage type 1 (M1) polarization on the CSZP coating. IL-4 could induce M2 polarization and promote osteogenesis of BMMSCs on CSZP in vivo and in vitro. In conclusion, the CSZP coating is an effective scaffold for BMMSCs osteogenesis, and IL-4 presents the additional advantage of modulating the immune response for bone regeneration on the CSZP coating in vivo. A chemical conversion calcium-strontium-zinc-phosphate (CSZP) coating is prepared on titanium. The CSZP coating exhibits micellar lamellar crystal morphology in micro-nano scale. The CSZP coating has an optimal topography and element composition for osteogenesis. Interleukin-4 assisted CSZP coating can obtain better osteoimmunomodulation properties.
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Filipović U, Dahmane RG, Ghannouchi S, Zore A, Bohinc K. Bacterial adhesion on orthopedic implants. Adv Colloid Interface Sci 2020; 283:102228. [PMID: 32858407 DOI: 10.1016/j.cis.2020.102228] [Citation(s) in RCA: 84] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 07/29/2020] [Accepted: 07/30/2020] [Indexed: 01/19/2023]
Abstract
Orthopedic implants are routinely used for fixation of fractures, correction of deformities, joint replacements, and soft tissue anchorage. Different biomaterials have been engineered for orthopedic implants. Previously, they were designed merely as mechanical devices, now new strategies to enhance bone healing and implant osteointegration via local delivery of molecules and via implant coatings are being developed. These biological coatings should enhance osteointegration and reduce foreign body response or infection. This article reviews current and future orthopedic implants, materials and surface characteristics, biocompatibility, and mechanisms of bacterial adhesion. Additionally, the review is addressing implant-related infection, the main strategies to prevent it and suggest possible future research that may control implant related-infection.
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Affiliation(s)
- Urška Filipović
- University Clinical Center of Ljubljana, Department of Traumatology, Zaloska 7, 1000 Ljubljana, Slovenia
| | - Raja Gošnak Dahmane
- University of Ljubljana, Faculty of Health Sciences, Zdravstvena pot 5, 1000 Ljubljana, Slovenia; University of Ljubljana, Faculty of Medicine, Institute of Anatomy, Korytkova 2, 1000 Ljubljana, Slovenia
| | | | - Anamarija Zore
- University of Ljubljana, Faculty of Health Sciences, Zdravstvena pot 5, 1000 Ljubljana, Slovenia
| | - Klemen Bohinc
- University of Ljubljana, Faculty of Health Sciences, Zdravstvena pot 5, 1000 Ljubljana, Slovenia.
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Yuan W, Xia D, Zheng Y, Liu X, Wu S, Li B, Han Y, Jia Z, Zhu D, Ruan L, Takashima K, Liu Y, Zhou Y. Controllable biodegradation and enhanced osseointegration of ZrO 2-nanofilm coated Zn-Li alloy: In vitro and in vivo studies. Acta Biomater 2020; 105:290-303. [PMID: 31972366 DOI: 10.1016/j.actbio.2020.01.022] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 01/11/2020] [Accepted: 01/15/2020] [Indexed: 12/13/2022]
Abstract
Zinc and its alloys have emerged as a new research direction of biodegradable metals (BMs) due to the significant physiological functions of Zn2+ ions in human body. However, low inhibitory concentration threshold value to cause cytotoxicity by Zn2+ ions during in vitro study and delayed osseointegration in vivo are two key flaws for the bulk Zn-based BMs. To combat these issues, we constructed a barrier layer of ZrO2 nanofilm on the surface of Zn-0.1(wt.%) Li alloy via atomic layer deposition (ALD). A decreased release of Zn2+ ions accompanied with accelerated release of Li+ ions was observed on account of galvanic coupling between the coating compositions and Zn-0.1Li alloy substrate. Cytocompatibility assay reflected that ZrO2 nanofilm coated Zn-0.1Li alloy exhibited improved cell adhesion and viability. Histological analysis also demonstrated better in vivo osseointegration for the ZrO2 nanofilm coated Zn-0.1Li alloy. Hence, the present study elucidated that the ALD of ZrO2 nanofilm on Zn-based BMs can effectively promote osseointegration and control their biodegradation behavior. STATEMENT OF SIGNIFICANCE: Zn-Li binary alloy was reported recently to be the promising biodegradable metals with ultimate tensile strength over 500 MPa, yet the low inhibitory concentration threshold value to cause cytotoxicity by Zn2+ ions is the obstacle needed to be overcome. As a pilot study, a systematic investigation on the ZrO2 nanofilm coated Zn-Li alloy, prepared by atomic layer deposition (ALD) technique, was conducted in the present study, which involved in the formation process, in vitro and in vivo degradation behavior as well as biocompatibility evaluation. We found a controllable corrosion rate and better in vivo osseointegration can be achieved by ZrO2 nanofilm coating on Zn-Li alloy, which provides new insight into the surface modification on biodegradable Zn alloys for usage within bone.
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Affiliation(s)
- Wei Yuan
- Department of Materials Science and Engineering, College of Engineering, Peking University, Beijing 100871, China
| | - Dandan Xia
- Department of Materials Science and Engineering, College of Engineering, Peking University, Beijing 100871, China
| | - Yufeng Zheng
- Department of Materials Science and Engineering, College of Engineering, Peking University, Beijing 100871, China; International Research Organization for Advanced Science and Technology, Kumamoto University, 2-39-1 Kurokami, Chuo-Ku, Kumamoto 860-8555, Japan.
| | - Xiangmei Liu
- Ministry-of-Education Key Laboratory for the Green Preparation and Application of Functional Materials, Hubei Key Laboratory of Polymer Materials, School of Materials Science & Engineering, Hubei University, Wuhan, 430062, China
| | - Shuilin Wu
- School of Materials Science & Engineering, The Key Laboratory of Advanced Ceramics and Machining Technology by the Ministry of Education of China, Tianjin University, Tianjin, 300072, China.
| | - Bo Li
- State Key Laboratory for Mechanical Behavior of Materials, Xi'an Jiaotong University, Xi'an 710049, China
| | - Yong Han
- State Key Laboratory for Mechanical Behavior of Materials, Xi'an Jiaotong University, Xi'an 710049, China.
| | - Zhaojun Jia
- Department of Chemistry and Chemical Biology, Rutgers University, Piscataway, NJ 08854, USA
| | - Donghui Zhu
- Department of Biomedical Engineering, Institute for Engineering-Driven Medicine, College of Engineering and Applied Sciences, Renaissance School of Medicine, Stony Brook University, 100 Nicolls Rd, Stony Brook, NY 11794, USA
| | - Liqun Ruan
- Department of Mechanical Systems Engineering, Graduate School of Science and Technology, Kumamoto University, Kurokami 2-39-1, Kumamoto-shi 860-8555, Japan
| | - Kazuki Takashima
- Department of Materials Science and Engineering, Faculty of Engineering, Kumamoto University, 2-39-1 Kurokami, Kumamoto 860-8555, Japan
| | - Yunsong Liu
- Department of Prosthodontics, Peking University School and Hospital of Stomatology, Beijing 100081, China; National Engineering Laboratory for Digital and Material Technology of Stomatology, National Clinical Research Center for Oral Diseases, Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China.
| | - Yongsheng Zhou
- Department of Prosthodontics, Peking University School and Hospital of Stomatology, Beijing 100081, China; National Engineering Laboratory for Digital and Material Technology of Stomatology, National Clinical Research Center for Oral Diseases, Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
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36
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Chen K, Xie X, Tang H, Sun H, Qin L, Zheng Y, Gu X, Fan Y. In vitro and in vivo degradation behavior of Mg-2Sr-Ca and Mg-2Sr-Zn alloys. Bioact Mater 2020; 5:275-285. [PMID: 32128466 PMCID: PMC7044521 DOI: 10.1016/j.bioactmat.2020.02.014] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 02/19/2020] [Accepted: 02/19/2020] [Indexed: 12/12/2022] Open
Abstract
Magnesium alloys with integration of degradability and good mechanical performance are desired for orthopedic implants. In this paper, Mg-2Sr-Ca and Mg-2Sr-Zn alloys were prepared and the degradation as well as the bone response were investigated. Compared with the binary Mg-2Sr alloys, the addition of Ca and Zn improved the in vitro and in vivo corrosion resistance. Mg-2Sr-Ca and Mg-2Sr-Zn alloys exhibited more uniform corrosion and maintained the configuration of the implants 4 weeks post-implantation. The in vivo corrosion rates were 0.85 mm/yr for Mg-2Sr-Zn and 1.10 mm/yr for Mg-2Sr-Ca in comparison with 1.37 mm/yr for Mg-2Sr. The in vitro cell tests indicated that Mg-2Sr-Ca and Mg-2Sr-Zn alloys exhibited higher MG63 cell viability than Mg-2Sr alloy. Furthermore, these two alloys can promote the mineralization and new bone formation without inducing any significant adverse effects and this sound osteogenic properties suggest its attractive clinical potential.
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Affiliation(s)
- Kai Chen
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, Beijing, 100083, China.,Beijing Advanced Innovation Centre for Biomedical Engineering, Beihang University, Beijing, 100083, China
| | - Xinhui Xie
- The Department of Orthopedics, ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, 210009, China.,Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong National Research Center for Rehabilitation Technical Aids, Beijing, 100176, China
| | - Hongyan Tang
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, Beijing, 100083, China.,Beijing Advanced Innovation Centre for Biomedical Engineering, Beihang University, Beijing, 100083, China
| | - Hui Sun
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, Beijing, 100083, China.,Beijing Advanced Innovation Centre for Biomedical Engineering, Beihang University, Beijing, 100083, China
| | - Ling Qin
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong National Research Center for Rehabilitation Technical Aids, Beijing, 100176, China
| | - Yufeng Zheng
- Department of Materials Science and Engineering, College of Engineering, Peking University, Beijing, 100871, China
| | - Xuenan Gu
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, Beijing, 100083, China.,Beijing Advanced Innovation Centre for Biomedical Engineering, Beihang University, Beijing, 100083, China
| | - Yubo Fan
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, Beijing, 100083, China.,Beijing Advanced Innovation Centre for Biomedical Engineering, Beihang University, Beijing, 100083, China.,National Research Center for Rehabilitation Technical Aids, Beijing, 100176, China
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37
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Gao A, Liao Q, Xie L, Wang G, Zhang W, Wu Y, Li P, Guan M, Pan H, Tong L, Chu PK, Wang H. Tuning the surface immunomodulatory functions of polyetheretherketone for enhanced osseointegration. Biomaterials 2019; 230:119642. [PMID: 31787332 DOI: 10.1016/j.biomaterials.2019.119642] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 11/14/2019] [Accepted: 11/19/2019] [Indexed: 12/31/2022]
Abstract
The adverse macrophage-mediated immune response elicited by the surface of polyetheretherketone (PEEK) is responsible for the formation of fibrous encapsulation and resulting inferior osseointegration of PEEK implants in the dental and orthopedic fields. Therefore, endowing the PEEK surface with immunomodulatory ability is an appealing strategy to enhance implant-bone integration. Herein, a reliable and cost-effective method to construct adherent films with tunable nanoporous structures on PEEK is described. The functionalized surface not only suppresses the acute inflammatory response of macrophages, but also provides a favorable milieu for osteogenic differentiation of human bone marrow mesenchymal stem cells (hBMSCs). Whole genome expression analysis reveals that the suppression effect arises from synergistic inhibition of focal adhesion, Toll-like receptor, and NOD-like receptor signaling pathways, as well as the attenuating loop through the JAK-STAT and TNF signaling pathways in macrophages. Further in vivo studies confirm that the functionalized surface induces less fibrous capsule formation and an improved bone regeneration. The nanoporous films fabricated on PEEK harmonize the early macrophage-mediated inflammatory response and subsequent hBMSCs-centered osteogenic functions consequently yielding superior osseointegration.
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Affiliation(s)
- Ang Gao
- Institute of Biomedicine and Biotechnology, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, 518055, China; Department of Physics, Department of Materials Science and Engineering, and Department of Biomedical Engineering, City University of Hong Kong, Tat Chee Avenue, Hong Kong, China
| | - Qing Liao
- Institute of Biomedicine and Biotechnology, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, 518055, China
| | - Lingxia Xie
- Institute of Biomedicine and Biotechnology, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, 518055, China
| | - Guomin Wang
- Department of Physics, Department of Materials Science and Engineering, and Department of Biomedical Engineering, City University of Hong Kong, Tat Chee Avenue, Hong Kong, China
| | - Wei Zhang
- Technical Institute of Physics and Chemistry, Chinese Academy of Sciences, Beijing, 100190, China
| | - Yuzheng Wu
- Institute of Biomedicine and Biotechnology, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, 518055, China
| | - Penghui Li
- Institute of Biomedicine and Biotechnology, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, 518055, China; Department of Physics, Department of Materials Science and Engineering, and Department of Biomedical Engineering, City University of Hong Kong, Tat Chee Avenue, Hong Kong, China
| | - Min Guan
- Institute of Biomedicine and Biotechnology, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, 518055, China
| | - Haobo Pan
- Institute of Biomedicine and Biotechnology, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, 518055, China
| | - Liping Tong
- Institute of Biomedicine and Biotechnology, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, 518055, China.
| | - Paul K Chu
- Department of Physics, Department of Materials Science and Engineering, and Department of Biomedical Engineering, City University of Hong Kong, Tat Chee Avenue, Hong Kong, China.
| | - Huaiyu Wang
- Institute of Biomedicine and Biotechnology, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, 518055, China.
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Ozan S, Lin J, Weng W, Zhang Y, Li Y, Wen C. Effect of thermomechanical treatment on the mechanical and microstructural evolution of a β-type Ti-40.7Zr-24.8Nb alloy. Bioact Mater 2019; 4:303-311. [PMID: 31709313 PMCID: PMC6829099 DOI: 10.1016/j.bioactmat.2019.10.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 10/15/2019] [Accepted: 10/17/2019] [Indexed: 12/11/2022] Open
Abstract
In this study, the microstructural evolution and mechanical properties of a newly developed Ti-40.7Zr–24.8Nb (TZN) alloy after different thermomechanical processes were examined. As-cast TZN alloy plates were solution-treated at 890 °C for 1 h, after which the thickness of the alloy plates was reduced by cold rolling at reduction ratios of 20%, 56%, 76%, and 86%. Stress-induced α” formation, {332} <113> β mechanical twinning, and kink band formation were observed in the cold-rolled TZN alloy samples. In the TZN sample after cold rolling at the 86% reduction ratio plus a recrystallization annealing at 890 °C for 1 h, the deformation products of a stress-induced α” phase, {332}<113> β mechanical twinning, and kink bands disappeared, resulting in a fine, equiaxed single β phase. The alloy samples exhibited elongation at rupture ranging from 7% to 20%, Young's modulus ranging from 63 to 72 GPa and tensile strength ranging from 753 to 1158 MPa. The TZN alloy sample after cold rolling and recrystallization annealing showed a yield strength of 803 MPa, a tensile strength of 848 MPa, an elongation at rupture of 20%, and an elastic admissible strain of 1.22%, along with the most ductile fractures during tensile testing. A newly developed Ti-40.7Zr–24.8Nb (TZN) alloy was thermomechanically processed. Deformation occurred via kink bands, mechanical twinning, and stress-induced α”. Cold rolling resulted in an increase in the tensile strength. Deformation products were disappeared after recrystallization annealing. TZN alloy can be considered as a promising candidate biomedical material.
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Affiliation(s)
- Sertan Ozan
- School of Engineering, RMIT University, Bundoora, Victoria, 3083, Australia
- Department of Mechanical Engineering, Yozgat Bozok University, 66100, Yozgat, Turkey
- Corresponding author. School of Engineering, RMIT University, Bundoora, Victoria, 3083, Australia.
| | - Jixing Lin
- Advanced Material Research and Development Center, Zhejiang Industry & Trade Vocational College, Wenzhou, Zhejiang, 325003, China
| | - Weijie Weng
- School of Engineering, RMIT University, Bundoora, Victoria, 3083, Australia
| | - Yaowu Zhang
- School of Engineering, RMIT University, Bundoora, Victoria, 3083, Australia
| | - Yuncang Li
- School of Engineering, RMIT University, Bundoora, Victoria, 3083, Australia
| | - Cuie Wen
- School of Engineering, RMIT University, Bundoora, Victoria, 3083, Australia
- Corresponding author.
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39
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Thompson RM, Fowler E, Culo B, Shellock FG. MRI safety and imaging artifacts evaluated for a cannulated screw used for guided growth surgery. Magn Reson Imaging 2019; 66:219-225. [PMID: 31704394 DOI: 10.1016/j.mri.2019.11.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 09/20/2019] [Accepted: 11/03/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Percutaneously-placed cannulated screws are the implant of choice for treatment of skeletal deformity associated with growing children that have spastic cerebral palsy (CP). These patients often require MRI examinations throughout their childhood to evaluate associated comorbidities and frequently for research protocols. There are concerns related to the use of MRI when metallic implants are present. Therefore, this study characterized MRI safety and imaging artifacts for a cannulated screw commonly used for guided growth. METHODS Standardized and well-accepted in vitro techniques were used to evaluate a cannulated screw (4.5 mm diameter x 50 mm length, 316 L stainless steel) for MRI issues. Static magnetic field interactions (i.e., translational attraction and torque) and artifacts were tested at 3-Tesla. Radiofrequency-related heating was assessed at 1.5-Tesla/64-MHz and 3-Tesla/128-MHz using relatively high levels of RF energy (whole-body averaged specific absorption rates of 2.7 W/kg and 2.9-W/kg, respectively). Artifacts were determined using T1-weighted, spin echo and gradient echo pulse sequences. RESULTS The cannulated screw exhibited minor magnetic field interactions (14° deflection angle, no torque). The highest temperature changes at 1.5-Tesla/64-MHz and 3-Tesla/128-MHz MRI were 2.1 °C and 2.4 °C, respectively. The maximum artifact size on a gradient echo sequence extended 20 mm relative to the dimensions of the implant. CONCLUSIONS The in vitro tests performed on the cannulated screw indicated that there were no substantial concerns with respect to the use of 1.5- and 3-Tesla MRI. Therefore, a patient with this cannulated screw can safely undergo MRI by following specific conditions to ensure safety.
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Affiliation(s)
- Rachel Mednick Thompson
- Orthopaedic Institute for Children, David Geffen School of Medicine at UCLA, 403 West Adams Blvd, Los Angeles, CA 90007, United States of America.
| | - Eileen Fowler
- UCLA/Orthopaedic Institute for Children Center for Cerebral Palsy, David Geffen School of Medicine, 1000 Veteran Ave., 22-70 Rehab Building, Los Angeles, CA 90095, United States of America.
| | - Bozena Culo
- Loyola Marymount University, 1 LMU Drive, Los Angeles, CA 90045, United States of America.
| | - Frank G Shellock
- Department of Radiology and Medicine, Keck School of Medicine, University of Southern California, 7751 Veragua Dr., Playa Del Rey, CA 90293, United States of America.
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40
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Radice S, Holcomb T, Pourzal R, Hallab NJ, Laurent MP, Wimmer MA. Investigation of CoCrMo material loss in a novel bio-tribometer designed to study direct cell reaction to wear and corrosion products. ACTA ACUST UNITED AC 2019; 18. [PMID: 30984811 DOI: 10.1016/j.biotri.2019.100090] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Wear and corrosion in total hip replacement negatively impact implant service-life and patient well-being. The aim of this study was to generate a statistical response surface of material loss using an apparatus, capable of testing the effect of wear and corrosion products in situ on cells, such as macrophages. The test chamber of a ball-on-flat tribometer operating inside a CO2 incubator was integrated with an electrochemical setup and adapted for cell culture work. A 20-test series, following a 2-level 3-factor design of experiments, was performed with a ceramic head in reciprocating rotational motion against a CoCrMo-alloy disc, under constant load. The lubricant was cell culture medium (RPMI-1640+10vol% bovine serum). Response surfaces were generated, which statistically showed the influence of motion amplitude, load, and potential on the total mass loss and wear scar volume of the metallic discs. Potential had the highest impact on the total mass loss, while motion amplitude and load significantly influenced the wear scar volume. The concentrations of the alloy elements found in the lubricants reflected the bulk-alloy stoichiometry. The total concentration of Co released into the lubricant (2.3-63 ppm by total mass loss, 1.5 to 62 ppm by ICP-MS) corresponded well with the known range to trigger cell response. Tribocorrosion tests in the presence of cells and tissues, such as macrophages, lymphocytes and/or synovium, will be carried out in the future.
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Affiliation(s)
- S Radice
- Department of Orthopedic Surgery, Rush UniversityMedical Center, Chicago, IL, USA
| | - T Holcomb
- Department of Orthopedic Surgery, Rush UniversityMedical Center, Chicago, IL, USA
| | - R Pourzal
- Department of Orthopedic Surgery, Rush UniversityMedical Center, Chicago, IL, USA
| | - N J Hallab
- Department of Orthopedic Surgery, Rush UniversityMedical Center, Chicago, IL, USA
| | - M P Laurent
- Department of Orthopedic Surgery, Rush UniversityMedical Center, Chicago, IL, USA
| | - M A Wimmer
- Department of Orthopedic Surgery, Rush UniversityMedical Center, Chicago, IL, USA
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41
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Soundhar A, Zubar HA, Sultan MTBHH, Kandasamy J. Dataset on optimization of EDM machining parameters by using central composite design. Data Brief 2019; 23:103671. [PMID: 30788395 PMCID: PMC6369405 DOI: 10.1016/j.dib.2019.01.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 01/03/2019] [Accepted: 01/10/2019] [Indexed: 12/02/2022] Open
Abstract
Newly prepared titanium alloy (Ti-13Zr-13Nb (TZN)) using powder metallurgy is considered in this investigation. Titanium alloys (TZN) are used in hip and knee replacement for orthopedic implants. Conventional machining, TZN alloys produce higher tool wear rate and poor surface quality, but this can be reduced by Electrical Discharge Machining (EDM) method. Moreover, EDM produce good biological and corrosion resistant surface. In this research, experiments were conducted by considering the influential process factors such as pulse on time, pulse off time, voltage, and current. The experiments were designed based on Response Surface Methodology (RSM) of face centered central composite design. Analysis of Variance (ANOVA) was conducted to identify the significance process factors and their relation to output responses such as Electrode Wear Rate (EWR), Surface Roughness (SR) and Material Removal Rate (MRR). Further, an empirical model was developed by RSM in order to predict the output responses.
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Affiliation(s)
- A Soundhar
- School of Mechanical Engineering, VIT University, Vellore, Tamilnadu, India
| | - H Abdul Zubar
- Faculty of Engineering, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Mohamed Thariq Bin Haji Hameed Sultan
- Laboratory of Biocomposite Technology, Institute of Tropical Forestry and Forest Products (INTROP), Universiti Putra Malaysia, 43400 Serdang, Selangor, Malaysia
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Jain S, Chowdhury R, Datta M, Chowdhury G, Mukhopadhyay AK. Characterization of the clonal profile of methicillin resistant Staphylococcus aureus isolated from patients with early post-operative orthopedic implant based infections. Ann Clin Microbiol Antimicrob 2019; 18:8. [PMID: 30760263 PMCID: PMC6373053 DOI: 10.1186/s12941-019-0307-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 02/05/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND To analyze the molecular epidemiology and to compare between the major methicillin resistant Staphylococcus aureus biotypes for association with patient characteristics who had an implant for closed fracture and developed early post-operative wound infections (POWI) in a tertiary care hospital of India. METHODS Pulsed-field gel electrophoresis (PFGE), antimicrobial resistance, accessory gene regulator (agr) and staphylococcal cassette chromosome mec (SCCmec) types, Paton-Valentine leukocidin (PVL) gene, toxin gene profiling, biofilm formation and patient demographics were correlated with MLST clonal complexes (CC). FINDINGS Overall eight different sequence types (STs) were detected with a predominance of ST239 (66%), ST22 (18%) and some minor types ST772, ST30 (4% each) ST1, ST642, ST6, ST107 (2% each). All ST239 isolates belong to CC239 and SCCmec III whereas ST22 isolates belong to CC22 and SCCmec IV. The isolates varied in the distribution of various toxin genes. With 63.63% biofilm formers ST239 were all multidrug resistant with frequent resistance to erythromycin, clindamycin, gentamicin, cefuroxime, amoxyclav and ciprofloxacin indicating doxycycline, amikacin, vancomycin and linezolid can be the drug of choice. CONCLUSION This study shows that ST239 MRSA is still most prevalent strain with new emergence of ST642 and ST107 isolates in association with orthopedic implant based POWI. As compare to other ST types ST239 strain was associated with adverse treatment outcomes. This highlights the importance of improving nosocomial infection control measures in this unit.
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Affiliation(s)
- Sonia Jain
- Infectious Diseases & Immunology Division, CSIR-Indian Institute of Chemical Biology, Kolkata, India.
| | - Rukhsana Chowdhury
- Infectious Diseases & Immunology Division, CSIR-Indian Institute of Chemical Biology, Kolkata, India
| | - Mousumi Datta
- Department of Community Medicine, Medical College & Hospital, Kolkata, India
| | - Goutam Chowdhury
- Division of Bacteriology, National Institute of Cholera and Enteric Diseases, Kolkata, India
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Ponder RI, Safaei M, Anton SR. Fabrication and selection of surrogate knee implant bearings for experimental evaluation of embedded in-vivo sensors. J Mech Behav Biomed Mater 2019; 91:237-246. [PMID: 30597377 DOI: 10.1016/j.jmbbm.2018.12.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 12/13/2018] [Accepted: 12/16/2018] [Indexed: 11/16/2022]
Abstract
Total Knee Replacement (TKR) is a common procedure that is gaining importance with the aging American population. Although TKR is common, about 20% of patients report being unhappy with their results. Previous research has pointed to misalignment and loosening as contributing factors to negative outcomes. What is lacking in the field of TKR is a sensory system that can determine the internal loads of the knee in a direct manner. Implant bearings embedded with piezoelectric transducers have already shown promise in providing accurate sensing data. To perform further experimentation, prototype implant bearings that can be accurately and efficiently produced are needed. This work investigates various fabrication processes and possible materials to provide a foundation for developing surrogate biomechanical implants, especially those with integrated smart sensors. In this study, an original knee bearing is scanned and the resulting geometries used to generate prototypes. The prototypes are fabricated using a variety of methods including CNC machining and additive manufacturing. The prototypes are then tested to determine load distribution, active sensor performance, as well as kinematic performance under loading. The results of this study show that FDM printing provides quick and affordable results but is not ideal for rigorous experimentation. SLA printed prototypes are improved in final quality with an increase in fabrication time. Lastly, CNC machined processes are more labor intensive but can provide the best material characteristics. The findings from this study aim to have an impact not only on researchers studying biomedical sensing, but on the field of biomechanical implants.
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Affiliation(s)
- Robert I Ponder
- Dynamic and Smart Systems Laboratory, Tennessee Technological University, Cookeville, TN 38505, USA.
| | - Mohsen Safaei
- Dynamic and Smart Systems Laboratory, Tennessee Technological University, Cookeville, TN 38505, USA.
| | - Steven R Anton
- Dynamic and Smart Systems Laboratory, Tennessee Technological University, Cookeville, TN 38505, USA.
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Pierre D, Swaminathan V, Scholl L, TenHuisen K, Gilbert JL. Effects of seating load magnitude and load orientation on seating mechanics in 5°40' mixed-alloy modular taper junctions. J Biomech 2018; 82:251-258. [PMID: 30501911 DOI: 10.1016/j.jbiomech.2018.10.037] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 10/03/2018] [Accepted: 10/29/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Mechanically-assisted crevice corrosion of modular tapers continues to be a concern in total joint replacements. Surgical factors that may affect taper seating mechanics include seating load magnitude and load orientation. Seating mechanics is defined as the seating load versus displacement behavior. In this study, mixed-alloy (CoCrMo/Ti-6Al-4V) modular head-neck 5°40' taper junctions were seated over a range of axially-oriented loads and off-axis orientations, capturing load-displacement during seating. The goals of the study were to assess the effects of seating load magnitude and load orientation on seating mechanics and correlate those findings with the taper pull-off load. METHODS A testing fixture measured head-neck seating displacement as the load was quasistatically applied. Motion was captured using two non-contact differential variable reluctance transducers which were mounted to the neck targeting the head. Seating experiments ranged from 1000 N to 8000 N. Load orientation ranged from 0° to 20° at 4000 N. RESULTS Seating load-displacement behavior at different seating loads showed a consistent characteristic behavior. Testing demonstrated increased seating displacement with seating load. Pull-off loads increased with seating load and were approximately 44% of the seating load across the range of seating loads investigated. Seating load orientation up to 20° had no significant effect on seating displacement and taper pull-off load. CONCLUSION Increased seating load magnitude increased seating displacement, work of seating and pull-off loads in mixed-alloy 5°40' head-neck tapers. Altering load orientation up to 20° off-axis had no significant effect. Direct measurements of seating mechanics provides insights into the locking of taper junctions.
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Affiliation(s)
- David Pierre
- Syracuse University, Syracuse Biomaterials Institute, Syracuse, NY, United States; Department of Bioengineering, Clemson University, Charleston, SC, United States
| | | | | | | | - Jeremy L Gilbert
- Syracuse University, Syracuse Biomaterials Institute, Syracuse, NY, United States; Department of Bioengineering, Clemson University, Charleston, SC, United States.
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Wellenberg RHH, Donders JCE, Kloen P, Beenen LFM, Kleipool RP, Maas M, Streekstra GJ. Exploring metal artifact reduction using dual-energy CT with pre-metal and post-metal implant cadaver comparison: are implant specific protocols needed? Skeletal Radiol 2018; 47:839-845. [PMID: 28842739 PMCID: PMC5915501 DOI: 10.1007/s00256-017-2750-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 07/26/2017] [Accepted: 08/01/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To quantify and optimize metal artifact reduction using virtual monochromatic dual-energy CT for different metal implants compared to non-metal reference scans. METHODS Dual-energy CT scans of a pair of human cadaver limbs were acquired before and after implanting a titanium tibia plate, a stainless-steel tibia plate and a titanium intramedullary nail respectively. Virtual monochromatic images were analyzed from 70 to 190 keV. Region-of-interest (ROI), used to determine fluctuations and inaccuracies in CT numbers of soft tissues and bone, were placed in muscle, fat, cortical bone and intramedullary tibia canal. RESULTS The stainless-steel implant resulted in more pronounced metal artifacts compared to both titanium implants. CT number inaccuracies in 70 keV reference images were minimized at 130, 180 and 190 keV for the titanium tibia plate, stainless-steel tibia plate and titanium intramedullary nail respectively. Noise, measured as the standard deviation of pixels within a ROI, was minimized at 130, 150 and 140 keV for the titanium tibia plate, stainless-steel tibia plate and titanium intramedullary nail respectively. CONCLUSION Tailoring dual-energy CT protocols using implant specific virtual monochromatic images minimizes fluctuations and inaccuracies in CT numbers in bone and soft tissues compared to non-metal reference scans.
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Affiliation(s)
| | - Johanna C. E. Donders
- Department of Orthopedic Surgery, AMC, Amsterdam, The Netherlands ,Orthopedic Trauma Service, Hospital for Special Surgery, New York, NY USA
| | - Peter Kloen
- Department of Orthopedic Surgery, AMC, Amsterdam, The Netherlands
| | - Ludo F. M. Beenen
- Department of Radiology, AMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | | | - Mario Maas
- Department of Radiology, AMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Geert J. Streekstra
- Department of Biomedical Engineering and Physics, AMC, Amsterdam, The Netherlands
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Abstract
Although implant removal is common after orthopedic trauma, indications for removal remain controversial. There are few data in the literature to allow evidence-based decision-making. The risk of complications from implant removal must be weighed against the possible benefits and the likelihood of improving the patient's symptoms.
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Abstract
Awareness of rare etiologies for implant failure is becoming increasingly important. In addition to the overall increase in joint arthroplasties, revision surgeries are projected to increase dramatically in the coming years, with volume increasing up to seven-fold between 2005 and 2030. The literature regarding the relationship between metal allergy and implant failure is controversial. It has proven difficult to determine whether sensitization is a cause or a consequence of implant failure. Testing patients with functional implants is not a clinically useful approach, as the rate of hypersensitivity is higher in implant recipients than in the general population, regardless of the status of the implant. As a result of the ineffectiveness of preoperative patch testing for predicting adverse outcomes, as well as the high cost of implementing such patch testing as standard procedure, most orthopedists and dermatologists agree that an alternative prosthesis should only be considered for patients with a history of allergy to a metal in the standard implant. In patients with a failed implant requiring revision surgery, hypersensitivity to an implant component should be considered in the differential diagnosis. Because a metal allergy to implant components is currently not commonly considered in the differential for joint failure in the orthopedic literature, there should be improved communication and collaboration between orthopedists and dermatologists when evaluating joint replacement patients with a presentation suggestive of allergy.
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Affiliation(s)
| | - Joseph A Gil
- Department of Orthopaedic Surgery, Warren Alpert Medical School, Brown University, Providence, RI, USA.
| | - Avi D Goodman
- Department of Orthopaedic Surgery, Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Gregory R Waryasz
- Department of Orthopaedic Surgery, Warren Alpert Medical School, Brown University, Providence, RI, USA
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Abstract
Total hip and knee replacement surgery using metal alloy devices is common. Type IV allergic reactions to these implants occur, though infrequently. While uncommon, peri-implant metal allergic reactions may cause significant morbidity for the affected individual-including aseptic loosening, pseudotumor formation and frank device failure. It is challenging to predict who will have these reactions, even in those with established pre-implant metal allergy. At this time, the scientific literature clearly supports few conclusions. Despite this, we believe several conclusions can be made: routine pre-implant testing in asymptomatic individuals is not indicated; listen to patient's concerns about metal allergy if the concern arises; patch testing is probably the best pre- and post-implant screening test; post-implantation testing is controversial and even positive LTT or patch test does not definitively diagnose morbidity from a metal allergy; and complete recovery following revision placement of an immunologically inert device is diagnostic. More research is needed to scientifically approach this issue.
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Affiliation(s)
- Wendy Z W Teo
- Department of Surgery (Dermatology), Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Peter C Schalock
- Department of Surgery (Dermatology), Geisel School of Medicine at Dartmouth, Hanover, NH, USA.
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Wang SP, Xu J. TiZrNbTaMo high-entropy alloy designed for orthopedic implants: As-cast microstructure and mechanical properties. Mater Sci Eng C Mater Biol Appl 2016; 73:80-89. [PMID: 28183676 DOI: 10.1016/j.msec.2016.12.057] [Citation(s) in RCA: 145] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 11/09/2016] [Accepted: 12/13/2016] [Indexed: 01/01/2023]
Abstract
Combining the high-entropy alloy (HEA) concept with property requirement for orthopedic implants, we designed a Ti20Zr20Nb20Ta20Mo20 equiatomic HEA. The arc-melted microstructures, compressive properties and potentiodynamic polarization behavior in phosphate buffer solution (PBS) were studied in detail. It was revealed that the as-cast TiZrNbTaMo HEA consisted of dual phases with bcc structure, major bcc1 and minor bcc2 phases with the lattice parameters of 0.3310nm and 0.3379nm, respectively. As confirmed by nanoindentation tests, the bcc1 phase is somewhat harder and stiffer than the bcc2 phase. The TiZrNbTaMo HEA exhibited Young's modulus of 153GPa, Vickers microhardness of 4.9GPa, compressive yield strength of σy=1390MPa and apparent plastic strain of εp≈6% prior to failure. Moreover, the TiZrNbTaMo HEA manifested excellent corrosion resistance in PBS, comparable to the Ti6Al4V alloy, and pitting resistance remarkably superior to the 316L SS and CoCrMo alloys. These preliminary advantages of the TiZrNbTaMo HEA over the current orthopedic implant metals in mechanical properties and corrosion resistance offer an opportunity to explore new orthopedic-implant alloys based on the TiZrNbTaMo concentrated composition.
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Affiliation(s)
- Shao-Ping Wang
- Shenyang National Laboratory for Materials Science, Institute of Metal Research, Chinese Academy of Sciences, 72 Wenhua Road, Shenyang, 110016, China
| | - Jian Xu
- Shenyang National Laboratory for Materials Science, Institute of Metal Research, Chinese Academy of Sciences, 72 Wenhua Road, Shenyang, 110016, China.
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Cheng A, Cohen DJ, Boyan BD, Schwartz Z. Laser-Sintered Constructs with Bio-inspired Porosity and Surface Micro/Nano-Roughness Enhance Mesenchymal Stem Cell Differentiation and Matrix Mineralization In Vitro. Calcif Tissue Int 2016; 99:625-637. [PMID: 27501817 DOI: 10.1007/s00223-016-0184-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 07/28/2016] [Indexed: 12/17/2022]
Abstract
Direct metal laser sintering can produce porous Ti-6Al-4V orthopedic and dental implants. The process requires reduced resources and time and can provide greater structural control than machine manufacturing. Implants in bone are colonized by mesenchymal stem cells (MSCs), which can differentiate into osteoblasts and contribute to osseointegration. This study examined osteoblast differentiation and matrix mineralization of human MSCs cultured on laser-sintered Ti-6Al-4V constructs with varying porosity and at different time scales. 2D solid disks and low, medium and high porosity (LP, MP, and HP) 3D constructs based on a human trabecular bone template were laser sintered from Ti-6Al-4V powder and further processed to have micro- and nanoscale roughness. hMSCs exhibited greater osteoblastic differentiation and local factor production on all 3D porous constructs compared to 2D surfaces, which was sustained for 9 days without use of exogenous factors. hMSCs cultured for 8 weeks on MP constructs in osteogenic medium (OM), OM supplemented with BMP2 or collagen-coated MP constructs in OM exhibited bone-like extracellular matrix mineralization. Use of bio-inspired porosity for the 3D architecture of additively manufactured Ti-6Al-4V enhanced osteogenic differentiation of hMSCs beyond surface roughness alone. This study suggests that a 3D architecture may enhance the osseointegration of orthopedic and dental implants in vivo.
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Affiliation(s)
- Alice Cheng
- Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, 313 Ferst Drive NW, Atlanta, GA, 30313, USA
- Department of Biomedical Engineering, Peking University, Peking University Hospital Building A503, Haidian District, Beijing, 100871, China
| | - David J Cohen
- Department of Biomedical Engineering, Virginia Commonwealth University, 601 West Main Street, Richmond, VA, 23284, USA
| | - Barbara D Boyan
- Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, 313 Ferst Drive NW, Atlanta, GA, 30313, USA.
- Department of Biomedical Engineering, Virginia Commonwealth University, 601 West Main Street, Richmond, VA, 23284, USA.
| | - Zvi Schwartz
- Department of Biomedical Engineering, Virginia Commonwealth University, 601 West Main Street, Richmond, VA, 23284, USA
- Department of Periodontics, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA
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